The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured.
BACKGROUND
Approximately 19% of non-elderly adults are without health insurance. The uninsured frequently lack a source of primary care and are more likely to use the emergency department (ED) for routine care. Improving access to primary care for the uninsured is one strategy to reduce ED overutilization and related costs.


METHODS
A comparison group quasi-experimental design was used to evaluate a broad-based community partnership that provided access to care for the uninsured-Project Access Dallas (PAD)-on ED utilization and related costs. Eligible uninsured patients seen in the ED were enrolled in PAD (n = 265) with similar patients not enrolled in PAD (n = 309) serving as controls. Study patients were aged 18-65 years, <200% of the federal poverty level and uninsured. Outcome measures include the number of ED visits, hospital days and direct and indirect costs.


RESULTS
PAD program enrollees had significantly fewer ED visits (0.93 vs. 1.44; P < 0.01) and fewer inpatient hospital days (0.37 vs. 1.07; P < 0.05) than controls. Direct hospital costs were ∼60% less ($1188 vs. $446; P < 0.01) and indirect costs were 50% less ($313 vs. $692; P < 0.01).


CONCLUSIONS
A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.
Texas Prevention Institute, School of Public Health, University of North Texas Health Science Center, Ft. Worth, TX 76107, USA. mark.dehaven@unthsc.edu
M
M
DeHaven
H
H
Kitzman-Ulrich
N
N
Gimpel
D
D
Culica
L
L
O'Neil
A
A
Marcee
B
B
Foster
M
M
Biggs
J
J
Walton
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017046:Cost Savings / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006265:Health Care Coalitions / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D011203:Poverty; D017678:Sex Distribution; D013781:Texas; D055815:Young Adult