Evaluation of care management for the uninsured

Med Care. 2011 Feb;49(2):166-71. doi: 10.1097/MLR.0b013e3182028e81.


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.

Method: 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.

Publication types

  • Evaluation Study

MeSH terms

  • California
  • Case Management / organization & administration*
  • Chi-Square Distribution
  • Emergency Service, Hospital* / statistics & numerical data
  • Female
  • Health Services Accessibility / organization & administration*
  • Health Services Research
  • Humans
  • Male
  • Medically Uninsured* / statistics & numerical data
  • Middle Aged
  • Multivariate Analysis
  • Organizational Objectives
  • Outcome Assessment, Health Care
  • Patient Admission* / statistics & numerical data
  • Primary Health Care / organization & administration*
  • Program Evaluation
  • Regression Analysis
  • Retrospective Studies
  • Statistics, Nonparametric