Community Health Access Program

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Community Health Access Program

• Heather Bittner Fagan, MD
• James M. Gill, MD MPHYu Ling, MA

Delaware Health Care Commission Meeting July 20,
2005
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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

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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)

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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)

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Breast Cancer Screening
Baseline Follow Up
P lt 0.05
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Cervical Cancer Screening
P lt 0.05
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Colorectal Cancer Screening
Baseline Follow Up
plt0.05
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Cholesterol Screening
Plt0.05
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Adult Immunizations
Baseline Follow Up
P lt 0.05
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Hospitalization Utilization
Baseline Follow Up
P lt 0.05
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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
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Interaction of CHAP and SFL
Baseline
Follow-up

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

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Understanding the geography of CHAP

• Demand where do CHAP enrollees come from
• Supply where are CHAP physicians and services
  located

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Where do Chap enrollees come from?
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Where are CHAP physicians located
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Does the supply of CHAP physicians meet the
demand of CHAP patients
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Where do Northern New Castle County CHAP
enrollees come from?
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Where do Southern New Castle County CHAP
enrollees come from?
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Where do Kent County CHAP enrollees come from?
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Where do Sussex County CHAP enrollees come from?
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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

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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

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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