Eliminating Patient Identified Barriers to Decrease Medicaid Inpatient Admission Rates and Improve Quality of Care.

BACKGROUND AND OBJECTIVES: The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care. METHODS: An initial survey identified which barriers to care our patients felt obstructed their care. With this data, along with a national literature review, our team used biweekly quality team meetings with LEAN methodology and Plan-Do-Study-Act cycles to create a 4-phase quality improvement project. A home-visit program to decrease distance to care, walk-in clinic to improve same-day access, strengthened collaboration with outside care managers and clinic staff to improve communication, and the introduction of an in-house phlebotomist to improve fragmented care were created and studied between June 2015 and December 2018. Admission rate, avoidable readmission rate, as well as other quality of care measurements were assessed with electronic medical record reports and through North Carolina Medicaid data reports. RESULTS: Overall Medicaid admissions decreased 32.7% from starting numbers, 40.2% below expected benchmarks. Avoidable readmissions decreased 41.8%, 53.8% below the expected benchmark. Improvements in same-day access numbers and lab completion rate were also seen. DISCUSSION: The team-based approach to eliminating patient-identified barriers decreased both admissions and avoidable readmissions for our Medicaid patients. It also improved quality-of-care measures. This approach has been shown to be beneficial at our clinic and can easily be replicated in other settings.

Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education.

BACKGROUND AND OBJECTIVE: The goal of this study was to decrease avoidable, low-acuity emergency department (ED) use among pediatric patients at Coastal Family Medicine. The rationale behind this focus was to improve continuity for our patients while decreasing the cost burden for low-acuity ED visits. The family medicine residency clinic pediatric panel has grown by 35% over the past 3 years, bringing this issue of same-day acute access in our clinic to the forefront. METHODS: A survey was created to better understand the needs of our high users of the ED. The survey identified that patients believed the ED provided better same-day access than our clinic during the daytime hours, 8 am-5 pm, Monday-Friday. By using this data, along with a literature review and a community practice review, a business-hour walk-in clinic for ages 0 years to 18 years was started to improve access. Clinic posters, revised scripting for office staff, phone room staff, and our after-hour triage line as well as bookmarks advertising the walk-in clinic given during well-child checks were created to address parent education. Pediatric ED data generated through our electronic medical record as well as through Medicaid reimbursement data framed the scope of this issue as significant. This was used to monitor pediatric ED visits following interventions as well. RESULTS: Over the initial 3 months of interventions, pediatric ED use decreased by 62 visits compared with the prior year. The low-acuity diagnoses of upper respiratory infections decreased by 43.7% (71 to 40 visits) and fever decreased by 50.0% (14 to 7 visits) from the same 3 months the year prior. This decrease was sustained when examined during year 3. Over the next 12 months, there were 284 (29.8%) less visits to the ED with low-acuity diagnoses. This calculates to approximately $300,000 saved to the Medicaid system. During this time frame, our pediatric panel increased by 200 patients. DISCUSSION: Increasing access and improving patient education decreased low-acuity pediatric ED visits in our clinic. This combination of interventions worked well in our community and has been shown to help optimize the setting in which pediatric patients are seen.