Eliminating Patient Identified Barriers to Decrease Medicaid Inpatient Admission Rates and Improve Quality of Care

Area of Science:

• Healthcare Management
• Quality Improvement in Medicine
• Patient-Centered Care

Background:

• Identified patient-reported barriers to care including distance, same-day access, communication, and fragmented care.
• Focused on 2296 Medicaid patients to decrease admission and readmission rates.
• Recognized the need to improve the quality of care for vulnerable patient populations.

Purpose of the Study:

• To decrease admission and readmission rates for Medicaid patients.
• To eliminate patient-identified barriers hindering quality of care.
• To implement and assess a multi-faceted quality improvement project.

Main Methods:

• Utilized a team-based, collaborative approach with LEAN methodology and Plan-Do-Study-Act cycles.
• Implemented a 4-phase project: home visits, walk-in clinic, enhanced care manager collaboration, and in-house phlebotomist.
• Collected data from electronic medical records and North Carolina Medicaid reports from June 2015 to December 2018.

Main Results:

• Achieved a 32.7% decrease in Medicaid admissions, significantly below benchmarks.
• Reduced avoidable readmissions by 41.8%, also below expected benchmarks.
• Observed improvements in same-day access and laboratory test completion rates.

Conclusions:

• A team-based strategy effectively reduced hospital admissions and readmissions for Medicaid patients.
• Addressing patient-identified barriers significantly improved overall quality of care.
• The demonstrated approach is beneficial and replicable in other healthcare settings.