Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor.
Am J Public Health. 2022 May;112(5):766-775. doi: 10.2105/AJPH.2021.306700. Epub 2022 Mar 24.
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. 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. 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; < .01) and ED visit costs (ARR = 0.96; < .01), but higher adjusted ratios of ambulatory care costs (ARR = 1.15; < .01) and no differences in inpatient or total costs compared with the usual-care group. 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. ClinicalTrials.gov identifier: NCT03924713. (. 2022;112(5):766-775. https://doi.org/10.2105/AJPH.2021.306700).
比较随机分配给常规服务的受益人与由 3 个医疗补助健康计划实施的社区卫生工作者 (CHW) 计划的医疗保健利用和成本。从 2018 年 2 月到 2019 年 6 月，密歇根州底特律市科迪 Rouge 社区的受益人居留超过 3 次急诊就诊或在过去 12 个月内至少有 1 次门诊护理敏感住院治疗，随机分配。CHW 联系符合条件的受益人为他们评估需求并为他们提供服务。我们比较了 12 个月内的急诊和门诊就诊、住院和相关费用。在 2457 名受益人的意向治疗分析中，随机分配到 CHW 计划的 1389 名受益人的急诊就诊调整后比率较低（调整后率比 [ARR] = 0.96； < .01），急诊就诊费用（ARR = 0.96； < .01），但门诊护理费用的调整后比率较高（ARR = 1.15； < .01），与常规护理组相比，住院和总费用无差异。针对服务不足社区的有效计划中门诊护理使用的最初增加可能会减轻急性护理使用减少带来的节省。应跟踪长期结果，以评估改善健康带来的潜在成本节省。临床试验.gov 标识符：NCT03924713。（2022 年；112（5）：766-775。https://doi.org/10.2105/AJPH.2021.306700）。
