Earlier Outpatient Treatment Could Lower Hospital Admissions

Analyzing access to primary care in New Jersey

From 1998 to 2000, researchers at the Health Research and Educational Trust of New Jersey, a nonprofit affiliate of the New Jersey Hospital Association, identified areas of New Jersey with barriers to primary care access.

Data sources included records for New Jersey patients hospitalized for ambulatory care-sensitive conditions such as asthma, diabetes, and gastroenteritis, which are likely to lead to hospitalization when not adequately treated or managed in primary care sites.

In addition, the research team conducted focus groups with consumers and professionals who live or work in those areas to identify possible reasons for, and solutions to, the problems of access barriers.

Key Findings
Based on the analysis of ambulatory care-sensitive admissions, the project director reported the following:

  • Virtually all of the zip codes with high rates of ambulatory care-sensitive conditions were urban, low-income neighborhoods.
  • Some low-income areas have rates of ambulatory care-sensitive conditions that are higher than others, while some areas have rates that are much lower than expected.
  • Chronic disease management appears to be of particular concern.
  • There were disparities in area admissions rates even for children.
  • There was a significant (12.1 percent) drop in rates of ambulatory care-sensitive conditions between 1995 and 1997.

Based on an analysis of focus groups findings, the project director reported the following:

  • Consumer frustration is caused by an insufficient number of doctors who accept Medicaid and the complicated paperwork required by HMOs and Medicaid.
  • Competing priorities cause consumers to give prevention a low priority.
  • Physicians' hours and locations often are inconvenient, especially for the working poor.
  • Language is a barrier for foreign-born and other non-English speaking persons.
  • Transportation is a barrier, with limited options for those living in rural areas, seniors, and those with disabilities.
  • Childcare barriers exist for mothers with preschoolers, making it difficult for them keep medical appointments.
  • Consumers perceive physicians as uncaring and judgmental.

Key Recommendations
Based on focus group suggestions, as well as the conclusions of other peer-reviewed studies, the research team developed 38 recommendations, grouped in four major areas, for New Jersey government and public health officials to consider to improve access to, and use of, primary care.

A few key recommendations include:

  • System Improvements:
    • Clinic hours should be expanded to evenings and weekends.
    • Work site-based health clinics and mobile units should be established.
  • Provider Practice Improvements and Education:
    • Cultural competency training for health care workers should be expanded.
    • More appointment slots should be made available.
  • Consumer Life Condition Improvements, Education and Advocacy:
    • Housing standards should be upgraded and environmental hazards controlled.
    • A range of educational and resource materials should be created in languages that reflect New Jersey's ethnically diverse population.
  • Future Surveillance and Research Initiatives:
    • Data collection and reporting in hospital emergency departments should be uniform.
    • All hospital admissions and emergency department visits for ambulatory care-sensitive conditions should be monitored.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $179,758.