Transcript Characteristics of Clients Using a Low Income Health Center

About the CCCHC
“Champaign County Christian Health Center is a not for
profit health center founded in 2003. Our mission is to show
and share the love of Jesus Christ to our neighbors of
Champaign County by providing holistic, free, and quality
health care services.”
507 S. Second St.
Suite 2E
Champaign, IL 61820
[email protected]
http://www.ccchc2003.org
About the CCCHC
 Provides:






primary care
immunizations
physicals
screenings
educational events
prayer and support
Problem & Objectives
 Problem
 A large population of uninsured and underinsured


Limited access to healthcare
Over-utilization of Emergency Department
(ED)
 Objectives
 Assess the clients of the Champaign County Christian
Health Center


Demographic Characteristics
Health Service Utilization
Methodology
 Self-reported client surveys completed
before receiving services from the
Champaign County Christian Health
Center (CCCHC)
 Ten optional questions that included demographic
information and health service utilization
 English and Spanish translations provided
 970 cases reviewed
 Secondary data analysis using (SPSS)
Statistical Package for the Social Sciences
Scholarly literature review of free health clinic
clientele
 75% of patients uninsured
 Over half lived within 200% of federal
poverty level
 Minorities make up 60% of the uninsured
American population
 Minority populations face:
 lower quality of health care
 lack access to care
Williams, David R and Jackson, Pamela Braboy Social Sources of Racial Disparities in Health, (2005,
March/April), Health Affairs Vol. 24(2)
Nadkarni, M. M. & Philbrick, J. T. (2005). Free clinics: A national survey. American Journal
of the Medical Sciences, 330(1), 25-31.
R ac e/E thnic ity of C linic vs . C ounty R es idents ***
P erc ent of
P atients
% C linic
80
60
40
20
0
74.9
45.2
29.6
11.4
White
% C ha m pa ig n
P opula tion
B lac k
9.2 8.1
As ian
11.9
H is panic
R ac e / E thnic ity
*** p< .001
http://quickfacts.census.gov/gfd/states/17/17019.html
4.0
4.1 1.6
Other
Age of Clinic vs. County Residents***
45
% Clinic
41.8
% Champaign County
40
35
32.5
30
26.3
26.8
25
Percent
20.3
19.2
20
15
10.8
10
5.9
5
4.9
3.7
1.2
1.1
0
Under 5
5 to 14
15-24
*** p<.001
http://quickfacts.census.gov/gfd/states/17/17019.html
25-44
Age
45-64
65-74
0.41.4
75 and
older
Female Headed Households of Clinic vs.
County Residents
% Female Headed Households
50
45.6%**
45
40
35
30
25
20
15
8.9%
10
5
0
*p<.05
CCCHC
http://quickfacts.census.gov/gfd/states/17/17019.html
Champaign
30
15.1
13.0 13.7
15
U
K
no
D
er
C
ity
t
en
s
er
t
en
/C
te
ta
lth
ea
tm
ar
ep
S
y/
nt
sw
an
ou
w
e
bl
da
ea
nr
er
th
’t
on
O
D
C
re
he
ow
de
si
ut
H
Source of Care
N
O
ity
lth
ea
n
ia
ic
ys
Ph
H
un
e
at
iv
Pr
lic
m
om
b
Pu
C
l
ta
pi
os
ED
H
*** p<.001
0.8
3.3
0.5
2.0
2.2
10
5
25.9
23.2
25
20
Percent
Alternative Sources of Health Care to Clinic***
0
Average National Emergency Department Utilization
Statistics
 In 2005, 115.3 million visits to ED’s (39.6 visits
per 100 people).
 An average of 30,000 visits per ED, a 31%
increase from 1995.
 41.9 million injury-related ED visits (14.4 visits
per 100 people)
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department
Summary. Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
Costs of ED Visits
 In 2003, average expenditure for an ED visit was
$560
 Average of $121 for an office-based visit
 Highest average ED expense for ages 45–64 at
$832
 ED expenses were slightly higher for males
than for females
Emergency Department Visits in the Past Year per
Person: CCCHC vs. National
1.2
Number of ED Visits per Person
1.04
1
0.8
0.6
0.396
0.4
0.2
0
CCCHC Patient
National
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
Scholarly literature findings on emergency
department utilization among uninsured
 25% patients visiting ED’s as primary
source of health care
 15-25% using ED as only source of care
 Strongest indicator of ED use is insurance
status
Hong, Rick, Baumann, Brigitte M. and Boudreaux, Edwin D ( 2007) The emergency department for routine
healthcare: Race/ethnicity, socioeconomic status, and perceptual factors [Electronic Version] Journal of
Emergency Medicine Vol. 32, Issue 2, pp 149-158
Frequency of ED Visits by CCCHC Patients***
600
558
Frequency
500
400
300
147
200
83
100
44
19
44
3 times
4 times
5 or
more
times
75
0
0 times
*** P<.001
1 time
2 times
Number of ED Visits in past year
Missing
Reasons for CCCHC Patient's ED Visits***
Frequency
100
80
60
40
20
0
*** p<.001
*632 cases N/A, did not visit ED within last year
Condition
Top Patient Reasons for Emergency Department Visit
CCCHC Patients
Average National ED
Patients in 2005
1. Injury
1. Stomach/Abdominal Pain
2. Gastric Symptoms
2. Chest Pain
3. Blood Pressure/ Problems
3. Fever
4. Cardiac Symptoms
4. Cough
5. Mental Health Conditions
5. Headache, pain in head
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
Urgency of ED Conditions: National vs. CCCHC
Urgency of Condition for National ED Visits
Urgency of Condition for CCCHC ED Visit
16.7%
30.8%
Unknown
Urgent
Urgent
34.6%
48.6%
Nonurgent
Nonurgent
69.2%
***p<.001
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
***
Total ED Visits by Gender: CCCHC vs. National
Averages*
% Clinic ED Visits
70
60
Percent ED 50
Visits
40
30
20
10
0
62.8
53.9
46.1
37.2
Male
*p<.05
% National ED Visits
Female
Gender
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
P erc ent of E D Vis its by R ac e: C C C HC vs . National
A verag es **
% C linic E D Visits
P erc ent of
E D Vis its
80
60
% Na tiona l E D Visits
74.7
45.2
40.7
40
21.9
20
1.4 1.1
0
White
B la c k
* Unable to c om pare s inc e His panic is re g arde d as
e thnic ity rathe r than rac e in national data
Asia n
2.7 *N/A
*N/A
Hispa nic
4.1 1.5
Othe r
R ac e / E thnic ity
**p< .01
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
Number ED Visits in Past Year
Average ED Visit per Female Head of Household*
1.5
1.25
1
0.87
0.5
0
Yes
*p<.0
No
Female Head of Household
Percent of Total ED Visits by Age: CCCHC vs.
National Average
% Clinic ED Visits
% National ED Visits
45
40
35
30
25
Percent ED Visits
20
15
10
5
0
41.6
32.7
28.8
19.7
16.2
11.2
0.95
19.2
10.0
8.6
5.9
3.3
Under 5 5 to 14
15-24
25-44
45-64
1.2
0.48
65-74
75 and
older
Age
Nawar EW, Niska RW, Xu J ( 2007) National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary.
Advance data from vital and health statistics; no. 386. National Center for Health Statistics
http://www.cdc.gov/nchs/data/ad/ad396.pdf
Limitations
 Self-reported data
 Difficulties in interpretation
 Surveys were not completed by all
clients
 Surveys were collected over a two year
period without date-stamping
Conclusions
 High rate of minority, female head of
household, and patients ages 25-64 using the
free clinic
 CCCHC patients followed national ED
utilization trends among uninsured
 Implications for ED overcrowding
References
1.) Cardarelli, R. & Chiapa, A. (2007). Educating primary care clinicians about health disparities.
Osteopathic Medicine and Primary Care, 1(5). Retrieved June 9, 2008 from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1808470.
2.) Cheong, P. H., Feeley, T. H. & Servoss, T. (2007). Understanding health inequalities for
uninsured Americans: A population-wide survey. Journal of Health Communication, 12(3), 285-300.
3.) Davidson, R. A., Guancola, A., Gast, A., Ho, J. & Waddell, R. (2003). Evaluation of access, a
primary care program for indigent patients: Inpatient and emergency room utilization. Journal of Community
Health, 28, 59-64.
4.) Diesburg-Stanwood, A., Scott, J., Oman, K. & Whitehill, C. (2004). Nonemergent ED patients
referred to community resources after medical screening examination: Characteristics, medical condition after 72 hours,
and use of follow-up services. Journal of Emergency Nursing, 30(4), 312-317.
5.) Hong, R., Baumann, B. M. & Boudreaux, E. D. (2007). The emergency department for routine
healthcare: Race/ethnicity, socioeconomic status, and perceptual factors. Journal of Emergency Medicine, 32(2), 149
158.
6.) Machlin, S. R. (2006). Expenses for a hospital emergency room visit. Agency for Healthcare
Research and Quality, 111. Retrieved June 11, 2008 from
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st111/stat111.pdf.
7.) Mayer, G. G., Villaire, M. & Connell, J. (2005). Ten recommendations for reducing
unnecessary emergency department visits. Journal of Nursing Administration, 35(10), 428-430.
8.) Nadkarni, M. M. & Philbrick, J. T. (2005). Free clinics: A national survey. American Journal
of the Medical Sciences, 330(1), 25-31.
9.) Nawar, E. W., Niska, R.W. & Xu, J. (2007). National hospital ambulatory medical care
survey: 2005 emergency department summary advance data from vital and health statistics. National Center for Health
Statistics, 386.Retrieved June 11, 2008 from http://www.cdc.gov/NCHS/data/ad/ad386.pdf.
10.) Oster, A. & Bindman, A. B. (2003). Emergency department visits for ambulatory care
sensitive conditions: Insights into preventable hospitalizations. Medical Care, 41(2), 198-207.
11.) SoRelle, R. (2006). Medicaid cuts could burden ED's with more uninsured patients.
Emergency Medicine News, 28(5), 133-134.1
12.) Williams, D. R. & Jackson, P. B. (2005). Social sources of racial disparities in health. Health
Affairs, 24, 325-334.
13.) Zlotnick, C. (2006). Community-versus individual-level indicators to identify pediatric
health care needs. Journal of Urban Health, 84, 45-59.
14.) Champaign County Census Data from US Census Buraeu http://quickfacts.census.gov/qfd/states/17/17019.html
 Compiled by Jennifer Byelick (2008)