title: Evaluation of care management for the uninsured.
abstract: BACKGROUND
  In 2008, Kern Medical Center established a Care Management Program (CMP) for low-income adults identified as frequent users of hospital services. Frequent users are defined as having 4 or more emergency department (ED) visits or admissions, 3 or more admissions, or 2 or more admissions and 1 ED visit within 1 year. The CMP helps patients access primary care and medical and social resources.
  
  
  OBJECTIVE
  To determine whether the CMP reduces ED visits and hospitalizations among frequent users.
  
  
  METHODS
  Between August 2007 and January 2010, a retrospective analysis was conducted using Kern Medical Center encounter data. ED visits and inpatient visits were compared pre- and postenrollment for care managed patients (n = 98). The analysis included a comparison group (n = 160) of frequent users matched on the basis of race and age. Multivariate analyses were performed to evaluate the difference in utilization between groups, and to adjust for potential group differences.
  
  
  RESULTS
  There was a reduction in the median number of ED visits per year from 6.0 ± 5.0 (median ± interquartile range) pre-enrollment to 1.7 ± 3.3 [corrected] postenrollment (P < 0.0001). The difference in inpatient admissions pre- and postenrollment was 0.0 ± 1.0 (P < 0.0001). After adjusting for multiple factors, multivariate analysis demonstrated that care managed patients had a 32% lower risk of visiting the ED than the comparison group (P < 0.0001). There was no difference in inpatient admissions between groups.
  
  
  CONCLUSIONS
  CMP that helps patients navigate the health care system and access social and medical resources show significant promise in reducing ED utilization.
authors.affiliation: COPE Health Solutions, Los Angeles, CA 90007, USA.
authors.forename: Reema
authors.initials: R
authors.lastname: Shah
authors.forename: Charlene
authors.initials: C
authors.lastname: Chen
authors.forename: Sheryl
authors.initials: S
authors.lastname: O'Rourke
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.forename: Sarita A
authors.initials: SA
authors.lastname: Mohanty
authors.forename: Jennifer
authors.initials: J
authors.lastname: Abraham
mesh_terms: D002140:California; D019090:Case Management / Q000458:organization & administration*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric