| Learning Objective #1: Describe a comprehensive, integrated research plan using Logic model as an organizing theme | |||
| Learning Objective #2: Apply psychosocial and outcome measures to their clinical practice, and understand their use for individuals, groups and populations |
Design: A nurse and social worker were teamed to assist clients in finding a primary care medical home, accessing available community resources, and managing their health.
Population, Sample, Setting, Years: The cross-sectional study sample included nearly 600 low-income, uninsured adults and children residing in Sedgwick County, Kansas, enrolled in the intervention from December 2001 through August 2003.
Methods: Using a logic model approach, the structure, process, outputs, and proximal and distal term outcomes were assessed. Statistical analyses included dependent t-test and ANOVA to assess changes in key outcome measures, and discriminant analysis to predict group membership for high, low and moderate health care resource consumption.
Concept or Variables Studied Together or Intervention and Outcome Variable(s): Structure measures included client characteristics, while process measures tracked key points during service delivery. Outcome measures included analyses of changes in health status, health locus of control, and health care resource consumption by participants.
Findings: The Case Management program has been effective in reducing ED visits for non-urgent health problems, linking clients to medical care homes, improving health status, and in achieving cost savings. CCM clients perceived less control over their health than healthy adults, and clients with low perceived social support consumed the largest number of health care resources. The difference between total numbers of ED visits pre versus post intervention was 2,040, with total charge avoidance achieved from December 2001 through February 2003 was $1,550,400.
Conclusions: The case management teams appear to be most effective in helping extremely high users of the ED, who may have complex social and/or health problems.
Implications: CCM is a potential solution for low-income, uninsured populations to navigate and access the fragmented, American health care delivery system.
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Sigma Theta Tau International
July 21, 2004