Reducing The Emergency Room Revolving Door Syndrome For The Poor, Uninsured And Chronically Ill Patient: Pilot Recommendations From A Process Improvement Evaluation

<p>CONTEXT: My Health LA (MHLA) is a Los Angeles County program that allows residents who are poor, without medical insurance (due to unaffordability and/or illegal immigration status), and without a primary care provider (un-empaneled) to enroll with an affiliated primary care clinic and receive free healthcare – related services.1 Despite the launch of this initiative in October 2014, 35 percent of MHLA enrollees did not follow-up with a primary care clinic and 15 percent of their emergency department (ED) visits were considered avoidable in fiscal year 2015-2016. OJECTIVE: In light of these findings, the MHLA enrollment pathway was evaluated at select agencies for the delineation of pilot improvement models. Design, Settings & Participants: Five sites were selected for the program evaluation, including a large urban medical center’s emergency and urgent care departments, and three primary care clinic sites adjacent to the medical center. Data inquiry, interagency observations, and patient and workforce interviews were conducted. MAIN OUTCOME MEASURES: The structure, process, and outcomes of the program were evaluated. Findings were compared with other evidence-based interventions for similar populations for the delineation of process improvement models. RESULTS: Identified successes within the enrollment pathway included free primary care services, use of a navigator in the ED, and improved chronic illness management. Identified challenges included flawed program perceptions, patient communication gaps, and current program limitations. CONCLUSION: A five-fold pilot process improvement model was proposed: short-term enhancement of communication surrounding the patient, short-term enhancement of communication to the patient at enrollment, medium-term enhancement of patient care coordination, medium to long-term initiation of financial incentives for clinics with satisfactory MHLA enrollee primary care engagement and long-term expansion of service coverage.</p>

Name thesis:degree_name

Doctor of Nursing Practice (DNP)

Level thesis:degree_level

Open Access Thesis

Discipline thesis:degree_discipline

Yale University School of Nursing

Year

2018

Author dc:creator

• Fassu Noulaheu, Stephanie

Contributors dc:contributor

• Judith Kunisch

• chronic medical illness
• emergency department
• hospital emergency services
• medically uninsured
• My Health LA
• primary care

Repository record dc:identifier

https://elischolar.library.yale.edu/ysndt/1060

OAI identifier oai:identifier

oai:elischolar.library.yale.edu:ysndt-1059