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J Am Board Fam Med. 2020 Mar-Apr;33(2):220-229. doi: 10.3122/jabfm.2020.02.190275.

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

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From the New Hanover Regional Medical Center, Wilmington, NC (TD, JB, SB, RW); Community Care of the Lower Cape Fear Wilmington, NC (SF).
From the New Hanover Regional Medical Center, Wilmington, NC (TD, JB, SB, RW); Community Care of the Lower Cape Fear Wilmington, NC (SF).



The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care.


An initial survey identified which barriers to care our patients felt obstructed their care. With this data, along with a national literature review, our team used biweekly quality team meetings with LEAN methodology and Plan-Do-Study-Act cycles to create a 4-phase quality improvement project. A home-visit program to decrease distance to care, walk-in clinic to improve same-day access, strengthened collaboration with outside care managers and clinic staff to improve communication, and the introduction of an in-house phlebotomist to improve fragmented care were created and studied between June 2015 and December 2018. Admission rate, avoidable readmission rate, as well as other quality of care measurements were assessed with electronic medical record reports and through North Carolina Medicaid data reports.


Overall Medicaid admissions decreased 32.7% from starting numbers, 40.2% below expected benchmarks. Avoidable readmissions decreased 41.8%, 53.8% below the expected benchmark. Improvements in same-day access numbers and lab completion rate were also seen.


The team-based approach to eliminating patient-identified barriers decreased both admissions and avoidable readmissions for our Medicaid patients. It also improved quality-of-care measures. This approach has been shown to be beneficial at our clinic and can easily be replicated in other settings.


Ambulatory Care Facilities; Electronic Health Records; Health Services Accessibility; House Calls; Medicaid; North Carolina; Patient Readmission; Primary Health Care; Quality Improvement; Surveys and Questionnaires

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