Impact of mailing information about nonurgent care on emergency department visits by Medicaid beneficiaries enrolled in managed care.
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.
Rector
T S
TS
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
Venus
P J
PJ
Laine
A J
AJ
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