Abstract
Background
Some Medicaid enrollees frequently utilize the emergency department (ED) due to barriers
accessing health care services in other settings.
Objectives
To determine whether an ED-initiated Patient Navigation program (ED-PN) designed to
improve health care access for Medicaid-insured frequent ED users could decrease ED
visits, hospitalizations, and costs.
Methods
We conducted a prospective, randomized controlled trial comparing ED-PN with usual
care (UC) among 100 Medicaid-enrolled frequent ED users (defined as 4–18 ED visits
in the prior year), assessing ED utilization during the 12 months pre- and post-enrollment.
Secondary outcomes included hospitalizations, outpatient utilization, hospital costs,
and Medicaid costs. We also compared characteristics between ED-PN patients with and
without reduced ED utilization.
Results
Of 214 eligible patients approached, 100 (47%) consented to participate. Forty-nine
were randomized to ED-PN and 51 to UC. Sociodemographic characteristics and prior
utilization were similar between groups. ED-PN participants had a significant reduction
in ED visits and hospitalizations during the 12-month evaluation period compared with
UC, averaging 1.4 fewer ED visits per patient (p = 0.01) and 1.0 fewer hospitalizations per patient (p = 0.001). Both groups increased outpatient utilization. ED-PN patients showed a trend
toward reduced per-patient hospital costs (−$10,201, p = 0.10); Medicaid costs were unchanged (−$5,765, p = 0.26). Patients who demonstrated a reduction in ED usage were older (mean age 42
vs. 33 years, p = 0.03) and had lower health literacy (78% low health literacy vs. 40%, p = 0.02).
Conclusion
An ED-PN program targeting Medicaid-insured high ED utilizers demonstrated significant
reductions in ED visits and hospitalizations in the 12 months after enrollment.
Keywords
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Article info
Publication history
Published online: March 14, 2020
Accepted:
December 4,
2019
Received in revised form:
November 26,
2019
Received:
June 20,
2019
Footnotes
NIH trial registry number: NCT01797068.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
