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Demonstrated health care cost savings for women: findings from a community health worker intervention designed to address depression and unmet social needs

Abstract

To evaluate the impact of a community health worker intervention (CHW) (referred to as Personalized Support for Progress (PSP)) on all-cause health care utilization and cost of care compared with Enhanced Screening and Referral (ESR) among women with depression. A total of 223 patients (111 in PSP and 112 in ESR randomly assigned) from three women’s health clinics with elevated depressive symptoms were enrolled in the study. Their electronic health records were queried to extract all-cause health care encounters along with the corresponding billing information 12 months before and after the intervention, as well as during the first 4-month intervention period. The health care encounters were then grouped into three mutually exclusive categories: high-cost (> US$1000 per encounter), medium-cost (US$201–$999), and low-cost (≤ US$200). A difference-in-difference analysis of mean total charge per patient between PSP and ESR was used to assess cost differences between treatment groups. The results suggest the PSP group was associated with a higher total cost of care at the baseline; taking this baseline difference into account, the PSP group was associated with lower mean total charge amounts (p = 0.008) as well as a reduction in the frequency of high-cost encounters (p < 0.001) relative to the ESR group during the post-intervention period. Patient-centered interventions that address unmet social needs in a high-cost population via CHW may be a cost-effective approach to improve quality of care and patient outcomes.

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Acknowledgments

We gratefully acknowledge the support from the University of Rochester School of Medicine’s Babigian Summer Research Fellowship and the Department of Psychiatry for funding the cost analysis; we also acknowledge and thank the Patient Centered Outcomes Research Institute, AD-12-4261, for funding the randomized comparative effectiveness trial.

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Correspondence to Ellen Poleshuck.

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The University of Rochester’s Institutional Review Board reviewed and approved this study. All aspects of this study where performed in accordance with institutional ethical standards and informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Embick, E.R., Maeng, D.D., Juskiewicz, I. et al. Demonstrated health care cost savings for women: findings from a community health worker intervention designed to address depression and unmet social needs. Arch Womens Ment Health 24, 85–92 (2021). https://doi.org/10.1007/s00737-020-01045-9

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  • DOI: https://doi.org/10.1007/s00737-020-01045-9

Keywords

  • Health care economics
  • Patient navigation
  • Women’s health
  • Mental health
  • Emergency department utilization
  • Social determinants of health