scholarly journals Access to primary care and cognitive impairment: results from a national community study of aging Americans

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Megan A. Mullins ◽  
Julie P. W. Bynum ◽  
Suzanne E. Judd ◽  
Philippa J. Clarke
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Cognitive Impairment ◽  
Racial Differences ◽  
Care Service ◽  
Emergency Department Utilization ◽  
Care Utilization ◽  
Access To Primary Care ◽  
Primary Care Supply

Abstract Background Despite a growing burden of Alzheimer’s Disease and related dementias (ADRD) in the US, the relationship between health care and cognitive impairment prevention is unclear. Primary care manages risk causing conditions and risk reducing behaviors for dementia, so we examine the association between individual and area-level access to primary care and cognitive impairment in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Methods REGARDS participants with a cognitive assessment and vascular measurements at their baseline visit were included in this cross-sectional analysis. Cognitive impairment was defined as a Six-Item Screener (SIS) score < 5. Primary care supply, primary care utilization and emergency department (ED) utilization were measured at the primary care service area (PCSA) level based on participant’s address. Individual access to care was self-reported. Models were adjusted for confounding by demographics, socioeconomic status and behavioral risk factors. Results Among 25,563 adults, living in a PCSA with low primary care supply was associated with 25% higher odds of cognitive impairment (OR 1.25 CI 1.07-1.45). Not having a regular source of medical care was associated with 14% higher odds of cognitive impairment (OR 1.14 CI 1.02-1.28), and living in a PCSA with high emergency department utilization was associated with 12% higher odds of cognitive impairment (OR 1.12 CI 1.02-1.23). Conclusions Our results are an important first step in understanding how health care may prevent cognitive impairment. They highlight the importance of primary care and suggest future work clarifying its role in preventing cognitive decline is imperative.

scholarly journals Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

2021 ◽  
Vol 8 (1) ◽  
pp. 18-28
Author(s):  
Paula Tanabe ◽  
Audrey L. Blewer ◽  
Emily Bonnabeau ◽  
Hayden B. Bosworth ◽  
Denise H. Clayton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
North Carolina ◽  
Sickle Cell Disease ◽  
Cost Benefit ◽  
Care Utilization ◽  
Evidence Based ◽  
Cell Disease ◽  
Ed Visits

Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.

Health care utilization following a non-urgent visit in emergency department and primary care

2010 ◽  
Vol 5 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Ann-Sofie Backman ◽  
Paul Blomqvist ◽  
Tobias Svensson ◽  
Johanna Adami
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Care Utilization

scholarly journals Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health

2018 ◽  
Vol 77 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Katherine D. Vickery ◽  
Nathan D. Shippee ◽  
Jeremiah Menk ◽  
Ross Owen ◽  
David M. Vock ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Managed Care ◽  
Health Care Utilization ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Organization ◽  
Medicaid Expansion ◽  
Accountable Care

Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.

Diverting Managed Care Medicaid Patients From Pediatric Emergency Department Use

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 170-178
Author(s):  
Anne M. Gadomski ◽  
Victoria Perkis ◽  
Lisa Horton ◽  
Sheila Cross ◽  
Bonita Stanton
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Managed Care ◽  
Health Outcomes ◽  
Pediatric Emergency ◽  
Care Utilization ◽  
Pediatric Emergency Department ◽  
Consecutive Case ◽  
Medicaid Children

Objective. To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider. Design. Consecutive case surveillance from 6/29/92 to 2/2/93. Setting. University based PED (17,500 visits/year) in inner city Baltimore. Participants. Cases were MAC children denied authorization to be seen for non-emergent conditions in the PED. Age and complaint matched MAC children were selected from the university based Pediatric Ambulatory Center (PAC) and from non-emergent PED visits (PED-seen) in order to compare utilization rates after denial. Intervention. The Maryland Access to Care (MAC) Medicaid program (started in 12/91) emphasizes primary care and appropriate health care utilization by incorporating the following elements of managed care: assignment to primary care provider, gatekeeping, mandatory enrollment and fee for service. Methods. Consecutive case surveillance from 6/29/92 to 2/2/93 was used to evaluate the health outcomes of MAC children denied authorization for non-emergent care in a university based PED. One week following denial, a pediatric nurse practitioner contacted the patient's caretaker and the MAC provider to ascertain health outcome. Medicaid claims data was used to compare the six month health care utilization of the denied group to age and complaint matched children seen in the PED (PED-seen) or in a primary care clinic (PAC). Results. 216 MAC patients were not authorized for a PED visit by their MAC providers. 123 (57%) saw their MAC provider within one week of the denied PED visit. 40 (18%) were not seen because their presenting complaint had resolved completely. No adverse health outcomes occurred because of delay in health care delivery. The subsequent ER utilization rate of the denied group was the same as the PED-seen comparison group, and significantly higher than that of the PAC group (P = .002). The denied group was hospitalized at a significantly higher rate relative to these comparison groups (P = .003). Conclusions. Diverting Medicaid children classified as non-emergent in an ER to their MAC providers can be a safe practice short-term. However, denial of a PED visit has no impact on subsequent ER utilization by Medicaid participants and may be associated with higher hospitalization rate. Gatekeeping in this setting does not necessarily change the health care seeking behavior of these patients.

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