Impact of Convenience Care on Pediatric ED Utilization:

1
Impact of Convenience Care on Pediatric ED
Utilization

• The El Centro de Corazón Pilot Project

2
Outline

• Project Background
• Intervention
• Evaluation Methods
• Time Series
• Pre-test Post-test
• Results
• Conclusions

3
Background Overview
El Centro de Corazón Pilot Project

• Project partners Texas Childrens Health Plan
  (TCHP), El Centro de Corazón (El Centro) St.
  Lukes Episcopal Charities and Rotary Club of
  Houston
• Objective To reduce ED utilization for
  ambulatory care sensitive conditions (ACSC) among
  TCHP beneficiaries who reside in east Houston.
• Strategy Provide expanded-hours primary care at
  a community clinic (El Centro/Eastwood Clinic) in
  east Houston.
• Pilot Project ran from Sept. 2006 Feb. 2007

4
Background Project Partners
Texas Childrens Health Plan

• Founded in 1996, TCHP was first group health
  plan exclusively for children.
• Catchment area includes Harris County and 10
  surrounding counties.
• Provides Medicaid STAR and CHIP coverage for
  170,000 enrollees.
• Primary care network includes
• 780 pediatricians
• 1,316 specialists
• 52 in-network hospitals (around greater Houston
  area)

5
Background Project Partners
El Centro de Corazón

• October 2003 merged with Eastwood Health Clinic.
  
• December 2003 obtained FQHC status.
• TCHP network provider
• Provides primary, preventive, dental and mental
  health services, lab and pharmacy services at 3
  sites in east Houston
• El Centro de Corazón Navigation
• El Centro/ Magnolia
• El Centro/ Eastwood

site of El Centro extended hours pilot project
6
Intervention
El Centro Extended-Hours Primary Care

7
Intervention
El Centro Extended-Hours Primary Care

• Clinic and Office Personnel
• Daytime (8AM 5PM)
• 1 nurse practitioner,
• 1 P/T and 2 F/T medical assistants,
• 3 staff members in front office
• Extended hours (5PM 8PM) and Sundays
• 1 physician assistant,
• 2 medical assistants
• 1 staff member in front office (2 on Sunday AM)

8
Intervention
TCHP Marketing and Educational Outreach

• Campaign ran Sept 2006 Feb 2007
• Outreach products printed in English and Spanish
• Sent to targeted TCHP enrollee households (HHs),
  not individuals

9
Intervention
TCHP Marketing and Educational Outreach
MEMO BOARD
MAGNET MAILER
10
Intervention
TCHP Marketing and Educational Outreach

• 6x9 Postcard
• Printed in English and Spanish
• Contains reminders about getting health care for
  a sick child
• Call physician
• Call TCHP Nurse Help Line
• Go to Eastwood Clinic

11
Intervention
TCHP Marketing and Educational Outreach

• Between Sept 2006 Feb 2007
• Distributed Rx Pads to 420 network PCP offices
• Made 274 visits to community based
  organizations, churches, apt. complexes, school
  nurses in study area (177 locations)
• Distributed 21,730 promotional flyers
• Auto dialer campaign delivered 10,000
  promotional messages over 2 months (number of
  messages received is unknown)

12
Evaluation Methods
Study Population

• Study Group
• TCHP enrollees who reside in 11 ZIP codes
  surrounding El Centro (approx. 18,000 children)
• Comparison Groups
• Matched Comparison group (approx. 7,600 children)
• Enrollees who reside in 7 ZIP codes with similar
  race/ethnicity, poverty levels, education, and
  use of English in household
• TCHP enrollee base excluding study group (approx.
  140,000 children)

13
Evaluation Methods
14
Evaluation Methods
Targeted EC Zip Codes, Matched Comparison Zip
Codes and Surrounding EDs and Community Clinic
Network
Community health centers are local, non-profit,
community-owned health care providers serving low
income and medically underserved communities.
(http//www.nachc.com/client/documents/America's_H
ealth_Centers_updated_1.08.pdf)
15
Evaluation Methods
Interrupted Time Series Sept 2005 Aug 2007

• Population perspective
• Measured monthly rates for ED use/100 enrollees
  (ED for ACSC visits and Total ED visits).
• Compared utilization trends for study group and
  2 comparison groups.

16
Evaluation Methods
Pre Post Test

• Clinical perspective
• Defined pre-pilot and post-pilot periods
• 6 months prior to and subsequent to pilot period
• Identified users and non-users of El Centros
  after hours services.
• Calculated user and non-user ED rates for
  pre-pilot, pilot and post-pilot time frames.

17
Results
18
Results
19
Results
20
Results
21
Results
22
Conclusions
Study Highlights

• At population level, pilot program did not
  successfully divert patients away from ED.
• At clinical-user level, effect was seen among
  users of El Centros after hours services
• 26 decrease in pre-post ED for ACSC utilization
  rate
• 50 decrease in pre-post total ED utilization
  rate.
• Study groups utilization of El Centros
  services increased during study period.
• Post-pilot drop in after hours visits might
  suggest continued outreach is needed.

23
Conclusions
Study Limitations

• Paid claims data might contain measurement error
  due to
• Timing of claim submission, clinical error and
  necessary adjustments
• Extended hours visits might be underestimated
  due to level of coding accuracy at provider
  level.
• El Centro hours of operation printed on outreach
  materials did not reflect the clinics actual
  hours.
• Effect of error on study group is unknown.
• We were unable to conduct statistical test of
  significance on pilot programs effect.
• We are currently working on a retrospective
  panel study to address this issue.

24
Acknowledgements
We would like to thank St. Lukes Episcopal
Charities and Rotary Club of Houston for their
support of the El Centro After Hours Pilot
Program, without which this project would not
have been possible. Additionally, we thank Rose
Calhoun and Xuan Tran with Texas Childrens
Health Plan for their assistance during the early
stages of the project.