199616 Use of Community Health Workers to Reduce Hospital Emergency Room Use: Evaluation of Texas CHIP Education Project

Sunday, November 8, 2009

Charles E. Begley , Management, Policy, and Community Health, University of Texas School of Public Health, Houston, TX
Carlos Eduardo Ramos, MPH , Houston Health Service Research Collaborative, University of Texas School of Public Health, Houston, TX
Objective: To assess State Children's Health Insurance Program (SCHIP) beneficiaries' satisfaction regarding a community health worker (CHW) intervention aimed at providing health insurance benefits education and to evaluate the impact of such intervention on physician and emergency department (ED) utilization rates in the greater Houston metropolitan area. Methods: Random monthly telephone surveys were conducted to families who received the intervention and obtained health services in the six months previous to the assessment; such questionnaire addressed questions associated with use of services, place of delivery (ED/PCP), establishment and utilization of a medical home, and relevance of information provided. To evaluate the health usage portion of the study, a pre and post intervention analysis comparing utilization of a control and intervention group was performed. Use of services was quantified through billing data provided by the Texas Health and Human Services Commission using current procedural terminology (CPT) codes. Results: The intervention was successful in achieving client satisfaction with 83% of those who remembered being served by CHWs (25%) indicating the intervention “helped a lot”. Almost 91% of the clients surveyed also acknowledged having a medical home six months after receiving the intervention. No increase in use physician services was observed after the intervention; however, a decrease in ED visits and costs did occur. While ED visits and costs declined in both the treatment and control groups after the intervention, a statistically significant (p=0.07) drop in utilization (33%) was observed in the latter group.

Learning Objectives:
1) To assess participants’ recollection and perceived relevance of an educational intervention provided by community health workers regarding the State Children’s Health Insurance Program. 2) To evaluate the impact of this educational intervention on the utilization rates of emergency department and physician visits (as measured by billing data).

Keywords: Underserved Populations, Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I recently obtain a master in public health and was involved in the literature review, research planning, development, and institutional review board submission for the mentioned project. I also developed the programming codes for the utilized database and performed the statistical analysis. Furthermore, I was responsible for conducting participants’ interviews and contributed extensively to the writing portion of the report.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.