The Potential Role of Nonclinical Patient Support Service Staff in Reducing Emergency Department Visits and Hospitalizations of Urban and Rural Patients of Health Centers Funded by the Health Resources and Services Administration

Abstract

Purpose

Payers such as Medicaid are concerned about high rates of potentially avoidable acute care utilization by beneficiaries called high-need, high-cost (HNHC) and frequently seen by Health Resources and Services Administration-funded health centers. Yet, health center HNHC patients have comparatively lower acute care utilization than patients of other primary care providers, possibly due to better access to nonclinical staff who provide patient support services, such as care coordination and self-management education. Furthermore, rural areas face provider shortages that may impact staffing capacity. We examined the association between capacity of staff who provide patient support services and rates of emergency department (ED) visits and hospitalizations at health centers by urban-rural status.

Methods

We used number of full-time equivalent (FTE) outreach workers and patient and community education specialists reported in the Uniform Data System with Medicaid claims data for HNHC Medicaid beneficiaries in California. We developed a negative binomial regression model to assess this relationship, accounting for patient demographics and health status.

Findings

We found a reduced rate of ED visits per patient per year given 4 or more hours per week of outreach workers versus none overall (−0.24) and for health center patients in rural areas (−1.02). Similarly, 4 or more hours per week of patient and community education specialists versus none was associated with fewer hospitalizations overall (−0.04) and among patients of urban (−0.04) health centers.

Conclusions

Findings suggest more care coordination and patient self-management education capacity at primary care providers may be correlated with reduced acute care utilization in rural and urban areas.