Abstract
An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal.
This study was made to determine the effects of these outreach services on (1) the use or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without outreach services, and utilization data were collected from their medical and administrative records.
The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services.
Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Office of Economic Opportunity, Health Services Office, Community Action Program:Guidelines, The Comprehensive Neighborhood Health Services Program. Government Printing Office, 1968.
Department of Health, Education, and Welfare:Guidelines for Development of Comprehensive Health Services Project, under Section 314(e) of the Public Health Service Act. Government Printing Office, Reprinted 1970.
Diehr P, Jackson KO, Boscha MV: The impact of outreach services on enrollees of a prepaid health insurance program.J Health Soc Behav 16326–340, 1975.
Domke HR, Coffey G: The neighborhood-based public health worker: Additional manpower for community health services.Am J Public Health 56603–608, 1966.
Luckham J, Swift D: Community health aides in the ghetto: The Contra Costa project.Med Care 7332, 1969.
Cauffman JG, Wingert WA, Friedman DB, et al: Community health aides: How effective are they?Am J Public Health 601904, 1970.
Moore FI, Stewart JC: Important variables influencing successful use of aides.Health Serv Rep 87555–561, 1972.
Greenlick MR: Medical services to poverty groups. In A Somers (ed):The Kaiser-Permanente Medical Care Program. New York, The Commonwealth Fund, 1971. Pp 138–148.
Colombo TJ, Saward EW, Greenlick MR: The integration of an OEO health program into a comprehensive group practice plan.Am J Public Health 59641–650, 1969.
Bamberger L: Health care and poverty: New directions in public policy for health care.Bull NY Aca Med 421140–1149, 1966.
Mullooly J:Description of the Kaiser-Permanente Neighborhood Health Center Population. Report to Department of Health, Education, and Welfare, Grant 002-P-20-2, 1975.
Greenlick MR, Hurtado AV, Pope CR, et al: Determinants of medical care utilization.Health Serv Res 3296–315, 1968.
Hurtado AV, Greenlick MR: A disease classification system for analysis of medical care utilization, with a note on symptom classification.Health Serv Res 6235–250, 1971.
Richardson WC: Poverty, illness and use of health services in the United States.Hospitals 4334–40, 1969.
Williams G:The Kaiser-Permanente Health Plan, Why It Works. Oakland, Henry J. Kaiser Foundation, 1971. Pp 44–47, 78–85.
Alpert JJ: Broken appointments.Pediatrics 3427, 1964.
Additional information
Dr. Freeborn is Associate Director, Dr. Mullooly is the statistician, Mr. Colombo is Associate Director, and Ms. Burnham is a research assistant at the Health Services Research Center, Kaiser Foundation Hospitals, 4610 S. E. Belmont St., Portland Oregon 97215. Requests for reprints should be addressed to Dr. Freeborn. This work was supported in part by grant 002-P-20-2 from the Department of Health, Education, and Welfare. It is based on a presentation made at the Annual Meeting of the American Public Health Association, Miami Beach, Florida, in October 1976. The authors wish to thank Ms. Phyllis Turner, technical editor.
Rights and permissions
About this article
Cite this article
Freeborn, D.K., Mullooly, J.P., Colombo, T. et al. The effect of outreach workers' services on the medical care utilization of a disadvantaged population. J Community Health 3, 306–320 (1978). https://doi.org/10.1007/BF01498507
Issue Date:
DOI: https://doi.org/10.1007/BF01498507