title: Impact of mailing information about nonurgent care on emergency department visits by Medicaid beneficiaries enrolled in managed care.
abstract: BACKGROUND
  Emergency department services may be used more appropriately if laypeople's knowledge of managing minor medical problems could be enhanced, especially since Medicaid applies a "prudent layperson" standard for providing access to emergency care.
  
  
  OBJECTIVE
  To investigate the effect of mailing a booklet, First Look, that informed Medicaid beneficiaries about care of common nonurgent conditions and encouraged use of alternatives to emergency care including care by office-based physicians, telephonic nursing assistance, and self-care.
  
  
  METHODS
  A randomized, parallel group study.
  
  
  METHODS
  Administrative data from 2 health plans serving urban Medicaid populations were used to identify households with a history of emergency department utilization (n = 3101 and n = 3822). Within each health plan, households were randomly assigned to receive First Look. The number of emergency department visits during 6.5 months of follow-up was the primary study endpoint.
  
  
  RESULTS
  Compared with controls, 1% fewer members of households that were mailed First Look visited an emergency department in each health plan (23% versus 24% in Plan A; 27% versus 28% in Plan B). The 95% confidence intervals on the observed differences were -3% to 1% and -4% to 1% in Plans A and B, respectively. The proportion of emergency department visits for conditions discussed in First Look was not significantly reduced in households that were mailed the booklet (62% versus 60% in Plan A and 51% versus 48% in Plan B).
  
  
  CONCLUSIONS
  Mailing First Look to Medicaid beneficiaries did not have a significant effect on use of emergency departments. Medicaid programs need to evaluate other, perhaps more multifaceted, interventions to promote appropriate use of emergency departments.
authors.affiliation: Center for Health Care Policy and Evaluation (MN008-W109) (TSR and PJV) and Medicaid Programs (MN012-S214) (AJL), UnitedHealth Group, Minneapolis, MN, USA. thomas_s_rector@uhc.com
authors.forename: T S
authors.initials: TS
authors.lastname: Rector
authors.forename: P J
authors.initials: PJ
authors.lastname: Venus
authors.forename: A J
authors.initials: AJ
authors.lastname: Laine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004194:Disease / Q000145:classification; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D014481:United States