title: Community-based case management for uninsured patients with chronic diseases: effects on acute care utilization and costs.
abstract: OBJECTIVE
  To examine the effects of a community-based case management program on acute health care utilization and associated costs in uninsured patients with 1 or more chronic diseases.
  
  
  METHODS
  Large regional academic medical center that provides health care services for the vast majority of indigent patients in the area.
  
  
  METHODS
  This was a retrospective study of 83 patients who enrolled in a case management program between April 2007 and August 2008 on the basis of 1 or more emergency department visits or acute hospitalizations. Paired t tests were used to compare utilization and costs before and after enrollment.
  
  
  RESULTS
  Overall, acute outpatient encounters decreased by 62% and inpatient admissions by 53%, whereas primary care visits increased by 162%. Participation in the case management program was also associated with a 41% reduction in overall aggregate costs, from $16,208 preintervention to $9,541 postintervention (p = .004).
  
  
  CONCLUSIONS
  The results of this study suggest that intensive case management can reduce acute care utilization and costs and increase primary care follow-up among uninsured patients with certain chronic diseases.
authors.affiliation: Community Health Program, University of Texas Medical Branch, Galveston, TX 77555, USA. alglende@utmb.edu
authors.forename: Alison
authors.initials: A
authors.lastname: Glendenning-Napoli
authors.forename: Beverly
authors.initials: B
authors.lastname: Dowling
authors.forename: John
authors.initials: J
authors.lastname: Pulvino
authors.forename: Gwen
authors.initials: G
authors.lastname: Baillargeon
authors.forename: Ben G
authors.initials: BG
authors.lastname: Raimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management / Q000191:economics / Q000458:organization & administration*; D002908:Chronic Disease; D003153:Community Health Services / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States; D055815:Young Adult