Community Health Access Program

Heather Bittner Fagan, MD

James M. Gill, MD MPHYu Ling, MA

Delaware Health Care Commission Meeting

July 20, 2005

Community Health Access Program(CHAP)

Matches low-income uninsured Delawareans with established health homes

Goal of program is to improve health by integrating services and improving access to existing resources

CHAP Evaluation 2004/2005

Health Care outcomes– Preventive care measures– Hospital Utilization

Role of CHAP in the Safety Net– Interaction with Screening for Life program

Geographical implications– Distribution of CHAP enrollees (demand)– Distribution of physicians (supply)

Preventive Care Outcomes

Data from 6/11/2001 to 10/15/2004 Analysis of two groups of CHAP patients

– 6 months continuous enrollment (n=1394)– 1 year continuous enrollment (n=512)

Measures used in previous analysis– Breast cancer screening (mammogram, breast

exam), cervical cancer screening (pap smear) , colorectal cancer screening (sigmoidoscopy, blood stool), cholesterol, adult immunizations (Pneumovax, influenza), hospital utilization (ER use and hospitalization)

Breast Cancer Screening

3888 61 68*

49 67* 52 61*

020406080

100

Breast Exam Mammograms

6month

1year

Baseline

Follow Up

* P < 0.05

Cervical Cancer Screening

7092*

6689*

020406080

100

Baseline Follow up

6month

1year

* P < 0.05

Colorectal Cancer Screening

2935

16 20

21 28*12 15

0

20

40

Colon/

sigm

oidosc

opy

Fecal

Occ

ult Blo

od

6month

1year

Baseline

Follow Up

* p<0.05

Cholesterol Screening

36 36

2248*

0

20

40

60

Baseline Follow up

6month

1year

* P<0.05

Adult Immunizations

0 0

33

44

814 13

21*

0

20

40

60

Peunomovax Influenza

6month

1year

Baseline

Follow Up

* P < 0.05

Hospitalization Utilization

16

9*8

11

159* 7 10

0

5

10

15

20

Per

cen

t

ER Use Hospitalization

6month

1year

Baseline

Follow Up

*P < 0.05

CHAP and SFL

Attempted to isolate the effects of CHAP and SFL to examine interaction of programs using index dates*

Looked at population as they entered CHAP (i.e. before “CHAP intervention”) to estimate the influence of SFL

Looked at change in rate in CHAP follow-up records before and after SFL index dates

* For women 1/1/02 and for men 10/1/03

Interaction of CHAP and SFL

2129

0

10

20

30

40

50

Perc

enta

ge

Before SFL After SFL

SFL alone 8% increase CHAP alone estimated 5-8% Combined effect 8%

3240

0

10

20

30

40

Per

cent

Baseline Follow-up

Understanding the geography of CHAP

Demand: where do CHAP enrollees come from

Supply: where are CHAP physicians and services located

Where do Chap enrollees come from?

Where are CHAP physicians located

Does the supply of CHAP physicians meet the demand of CHAP patients

Where do Northern New Castle County CHAP enrollees come from?

Where do Southern New Castle County CHAP enrollees come from?

Where do Kent County CHAP enrollees come from?

Where do Sussex County CHAP enrollees come from?

Summary

CHAP improves health outcomes CHAP in conjunction with SFL leaves CRC

screening suboptimal The distribution of physicians in the CHAP

program mirrors the need of CHAP enrollees

Future Work

Move away from survey and preventive health outcomes

Move towards disease management Further understanding of CHAP synergy

through the state CRC screening program Estimate the magnitude of CHAP supply and

demand with geo mapping

New CHAP model

Disease management– Based on age of population: obesity, smoking,

HTN

Measuring the ability of program to help a vulnerable population navigate the health system– Health literacy