文章基本信息

标题：Impact on Health Care Utilization and Costs of a Medicaid Community Health Worker Program in Detroit, 2018-2020: A Randomized Program Evaluation.
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作者：Michele Heisler ; Adrienne Lapidos ; Edith Kieffer 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2022
卷号：112
期号：5
页码：766-775
DOI：10.2105/AJPH.2021.306700
语种：English
出版社：American Public Health Association
摘要：Objectives.To compare health care utilization and costs between beneficiaries randomly assigned to usual services versus a community health worker (CHW) program implemented by 3 Medicaid health plans.Methods.From February 2018 to June 2019, beneficiaries residing in Detroit, Michigan's Cody Rouge neighborhood with more than 3 emergency department (ED) visits or at least 1 ambulatory care‒sensitive hospitalization in the previous 12 months were randomized. CHWs reached out to eligible beneficiaries to assess their needs and link them to services. We compared ED and ambulatory care visits, hospitalizations, and related costs over 12 months.Results.In intention-to-treat analyses among 2457 beneficiaries, the 1389 randomized to the CHW program had lower adjusted ratios of ED visits (adjusted rate ratio [ARR] = 0.96;P < .01) and ED visit costs (ARR = 0.96;P < .01), but higher adjusted ratios of ambulatory care costs (ARR = 1.15;P < .01) and no differences in inpatient or total costs compared with the usual-care group.Conclusions.Initial increases in ambulatory care use from effective programs for underserved communities may mitigate savings from decreased acute care use. Longer-term outcomes should be followed to assess potential cost savings from improved health.Trial Registration:ClinicalTrials.gov identifier: NCT03924713. (Am J Public Health. 2022;112(5):766-775. https://doi.org/10.2105/AJPH.2021.306700).