title: Mobile clinic in Massachusetts associated with cost savings from lowering blood pressure and emergency department use.
abstract: Mobile health clinics are in increasingly wide use, but evidence of their clinical impact or cost-effectiveness is limited. Using a unique data set of 5,900 patients who made a total of 10,509 visits in 2010-12 to the Family Van, an urban mobile health clinic in Massachusetts, we examined the effect of screenings and counseling provided by the clinic on blood pressure. Patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg and 6.2 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.2 percent and 44.6 percent reductions in the relative risk of myocardial infarction and stroke, respectively, which we converted into savings using estimates of the incidence and costs of these conditions over thirty months. The savings from this reduction in blood pressure and patient-reported avoided emergency department visits produced a positive lower bound for the clinic's return on investment of 1.3. All other services of the clinic-those aimed at diabetes, obesity, and maternal health, for example-were excluded from this lower-bound estimate. Policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments.
authors.affiliation: Harvard Medical School, Boston, MA, USA. zirui_song@hms.harvard.edu
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
authors.forename: Caterina
authors.initials: C
authors.lastname: Hill
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bennet
authors.forename: Anthony
authors.initials: A
authors.lastname: Vavasis
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Oriol
mesh_terms: D001794:Blood Pressure; D001900:Boston; D017046:Cost Savings / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000191:economics; D008507:Medically Underserved Area; D008875:Middle Aged; D008952:Mobile Health Units / Q000191:economics* / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control; D010353:Patient Education as Topic / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D014481:United States