APPROACHES TO REDUCING POTENTIALLY AVOIDABLE HOSPITAL UTILIZATION IN MARYLAND: EXAMINING THE HEALTH ENTERPRISE ZONE INITIATIVE AND CRISP ENCOUNTER NOTIFICATION SERVICE

This dissertation examines two programs that aim to reduce potentially avoidable hospital use: the Health Enterprise Zone (HEZ) Initiative and the Encounter Notification Service (ENS). Potentially avoidable utilization (PAU) is defined as hospital care for ambulatory care sensitive conditions that could have been prevented through the provision of timely and effective care. The HEZ Initiative is a four-year community based intervention implemented in Maryland to improve access to care and ENS is a health information technology tool that can trigger important care coordination activities. The objectives of this dissertation are to: 1) examine the association between the HEZ Initiative and inpatient and emergency department utilization for seven targeted ambulatory care sensitive conditions; 2) examine the association between the HEZ Initiative and inpatient and emergency department utilization for the Medicaid population; and 3) describe the adoption and use of ENS in Maryland and Washington, D.C. In a longitudinal study, manuscript one examines the association between the implementation of a four-year community based intervention, the HEZ Initiative, and changes inpatient and emergency department (ED) use for seven ambulatory care sensitive conditions. The HEZ Initiative was associated with a decrease in inpatient discharges related to cardiovascular conditions and diabetes; and an increase in utilization related to inpatient and ED pediatric asthma, certain inpatient behavioral health conditions. Manuscript two examines the association between the HEZ Initiative and hospital use for the Medicaid population in Maryland over time – specifically measuring changes in total inpatient and emergency department discharges as discharges for ambulatory care sensitive conditions using a Prevention Quality Indicator composite measure and a HEZ condition composite measure. Among the Medicaid population, the HEZ Initiative was associated with an overall decrease in inpatient discharges and increase in ED visits. Manuscript three is a descriptive study of the adoption and use of ENS over two years, examining the demographics of patients for whom notifications were sent as well as describing the use and preferences for care entities that adopt the technology. The study found that ENS was adopted at a growing rate and that a wide range of organizations received ENS notifications