Reducing the Emergency Department Revolving Door Syndrome for the Poor, Uninsured, and Chronically Ill Patient in Los Angeles: Process Improvement Recommendations from a County Health Program Evaluation.

Population Health Management
Stephanie Fassu Noulaheu

Abstract

My Health LA (MHLA), a Los Angeles countywide health program, connects eligible uninsured poor residents with partner primary care clinics and a range of free health care services. Nevertheless, primary care nonengagement and inadequate emergency department (ED) visits remained significant in this population in fiscal year 2015-2016. This evaluation examined the structure, process and outcomes of MHLA at select participating agencies to delineate pilot improvement models. Five sites were selected for the program evaluation, including a large urban ED, its affiliated urgent care clinic, and 3 partner primary care clinics. Data inquiry, interagency observations, and patient and workforce interviews were conducted. The structure, process, and outcomes of the program were evaluated and compared with other evidence-based interventions with similar populations. Successes identified in the enrollment pathway included free primary care services, use of a navigator in the ED, and perceived improvement to chronic illness management. Challenges identified included flawed program perceptions, patient communication gaps, and current program limitations. A 5-fold pilot process improvement model was proposed: enhancement of communication surr...Continue Reading

References

May 14, 2008·Health Affairs·Donald M BerwickJohn Whittington
Aug 6, 2008·Annals of Internal Medicine·Andrew P WilperDavid U Himmelstein
Jun 27, 2013·Journal of Primary Care & Community Health·Ted MackinneyJeff Whittle
Jan 1, 2012·Journal of Health Care for the Poor and Underserved·Wenke HwangKristie Long Foley
Apr 20, 2014·Preventing Chronic Disease·Brian W WardRichard A Goodman
Aug 13, 2014·Health Services Research·Guy DavidSomesh Nigam

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