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Community Health Access Program

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Matches low-income uninsured Delawareans with established health homes ... Breast cancer screening (mammogram, breast exam), cervical cancer screening (pap ... – PowerPoint PPT presentation

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Title: Community Health Access Program


1
Community Health Access Program
  • Heather Bittner Fagan, MD
  • James M. Gill, MD MPHYu Ling, MA

Delaware Health Care Commission Meeting July 20,
2005
2
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

3
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)

4
Preventive Care Outcomes
  • Data from 6/11/2001 to 10/15/2004
  • Analysis of two groups of CHAP patients
  • 6 months continuous enrollment (n1394)
  • 1 year continuous enrollment (n512)
  • 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)

5
Breast Cancer Screening
Baseline Follow Up
P lt 0.05
6
Cervical Cancer Screening
P lt 0.05
7
Colorectal Cancer Screening
Baseline Follow Up
plt0.05
8
Cholesterol Screening
Plt0.05
9
Adult Immunizations
Baseline Follow Up
P lt 0.05
10
Hospitalization Utilization
Baseline Follow Up
P lt 0.05
11
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
12
Interaction of CHAP and SFL
Baseline
Follow-up
  • SFL alone 8 increase
  • CHAP alone estimated 5-8
  • Combined effect 8

13
Understanding the geography of CHAP
  • Demand where do CHAP enrollees come from
  • Supply where are CHAP physicians and services
    located

14
Where do Chap enrollees come from?
15
Where are CHAP physicians located
16
Does the supply of CHAP physicians meet the
demand of CHAP patients
17
Where do Northern New Castle County CHAP
enrollees come from?
18
Where do Southern New Castle County CHAP
enrollees come from?
19
Where do Kent County CHAP enrollees come from?
20
Where do Sussex County CHAP enrollees come from?
21
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

22
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

23
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
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