{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:10:08Z","timestamp":1777932608877,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Population Health Management"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>My Health LA (MHLA), a Los Angeles countywide health program, connects eligible uninsured poor residents with partner primary care clinics and a range of free health care services. Nevertheless, primary care nonengagement and inadequate emergency department (ED) visits remained significant in this population in fiscal year 2015\u20132016. This evaluation examined the structure, process and outcomes of MHLA at select participating agencies to delineate pilot improvement models. Five sites were selected for the program evaluation, including a large urban ED, its affiliated urgent care clinic, and 3 partner primary care clinics. Data inquiry, interagency observations, and patient and workforce interviews were conducted. The structure, process, and outcomes of the program were evaluated and compared with other evidence-based interventions with similar populations. Successes identified in the enrollment pathway included free primary care services, use of a navigator in the ED, and perceived improvement to chronic illness management. Challenges identified included flawed program perceptions, patient communication gaps, and current program limitations. A 5-fold pilot process improvement model was proposed: enhancement of communication surrounding the patient, enhancement of communication with the patient at enrollment, enhancement of patient care coordination, initiation of financial incentives for clinics with satisfactory enrollee engagement, and expansion of service coverage. The proposed model can be applied to promote primary care engagement and adequate ED use for similar underserved populations elsewhere.<\/jats:p>","DOI":"10.1089\/pop.2020.0036","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T16:20:56Z","timestamp":1595348456000},"page":"376-384","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reducing the Emergency Department Revolving Door Syndrome for the Poor, Uninsured, and Chronically Ill Patient in Los Angeles: Process Improvement Recommendations from a County Health Program Evaluation"],"prefix":"10.1177","volume":"24","author":[{"given":"Stephanie Fassu","family":"Noulaheu","sequence":"first","affiliation":[{"name":"School of Nursing, Yale University, New Haven, Connecticut, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"1","article-title":"Who are the remaining uninsured and why haven't they signed up for coverage?","volume":"24","author":"Collins SR","year":"2016","unstructured":"Collins SR, , Gunja MZ, , Doty MM, , Beutel S. Who are the remaining uninsured and why haven't they signed up for coverage?. Issue Brief (Commonw Fund), 2016; 24:1\u201320.","journal-title":"Issue Brief (Commonw Fund)"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-3-200808050-00006"},{"key":"e_1_3_3_4_2","unstructured":"Collins SR Davis K Doty MM Kriss JL Holmgren A L . Gaps in health insurance: An all-American problem. Commonwealth Fund. 2006. www.commonwealthfund.org\/Content\/Publications\/Fund-Reports\/2006\/Apr\/Gaps-in-Health-Insurance-An-All- American-Problem.aspx Accessed June25 2016."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2010.191569"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.5888\/pcd11.130389"},{"key":"e_1_3_3_7_2","unstructured":"Devol R Bedroussian A . An unhealthy America: the economic burden of chronic disease\u2014charting a new course to save lives and increase productivity and economic growth. Milken Institute. 2007. http:\/\/assets1c.milkeninstitute.org\/assets\/Publication\/ResearchReport\/PDF\/chronic_disease_report.pdf Published Accessed March18 2017."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2015.03.019"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000045021.70297.9F"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/NCM.0b013e3182687f2b"},{"key":"e_1_3_3_11_2","unstructured":"Los Angeles County Department of Health Services. My Health LA Annual Report to the Los Angeles County Board of Supervisors\u2014Fiscal Year 2015\u20132016. 2017. http:\/\/file.lacounty.gov\/SDSInter\/dhs\/1010204_2015\u201316MHLAAnnualReport(final).pdf Accessed May1 2017."},{"key":"e_1_3_3_12_2","unstructured":"Luftig-Viste A Conolly J . My Health LA updates. 2016. http:\/\/publichealth.lacounty.gov\/sapc\/media\/MHLA\/PDF\/MHLASAPC061516.pdf Accessed May2 2017."},{"key":"e_1_3_3_13_2","unstructured":"Los Angeles County Department of Health Services. My Health LA Annual Report to the Los Angeles County Board of Supervisors\u2014Fiscal Year 2017\u20132018. 2018. http:\/\/file.lacounty.gov\/SDSInter\/dhs\/1049638_2017\u201318MHLAAnnualReportFINAL.pdf Accessed April29 2020."},{"key":"e_1_3_3_14_2","unstructured":"California Healthcare Foundation . California Emergency Departments 2018: Use Grows as Coverage Expands. 2018. https:\/\/www.chcf.org\/wp-content\/uploads\/2018\/08\/CAEmergencyDepartments2018.pdf Accessed May1 2020."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410120089033"},{"key":"e_1_3_3_16_2","unstructured":"McDonald KM Sundaram V Bravata DM et al. Closing the quality gap: a critical analysis of quality improvement strategies (vol. 7: care coordination). Agency for Healthcare Research and Quality. 2007. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK44008\/ Accessed March10 2017."},{"key":"e_1_3_3_17_2","unstructured":"US Census Bureau . Communities facts American fact finder. 2016. https:\/\/factfinder.census.gov\/faces\/nav\/jsf\/pages\/community_facts.xhtml Accessed January21 2018."},{"key":"e_1_3_3_18_2","unstructured":"California Healthcare Almanac. Medi-cal facts and figures: crucial coverage for low-income Californians. 2019. https:\/\/www.chcf.org\/wp-content\/uploads\/2019\/02\/MediCalFactsFiguresAlmanac2019.pdf Accessed May16 2020."},{"key":"e_1_3_3_19_2","unstructured":"Los Angeles County Department of Health Services. Bi-directional referrals between the Department of Health services and community partners. 2015. http:\/\/file.lacounty.gov\/SDSInter\/dhs\/225125_PIN15-01Bi-directionalReferralsBetweentheDHSandCommunityPartners.pdf Accessed May1 2017."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150131913477116"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2012.0121"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/2150131913478981"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12218"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.27.3.759"}],"container-title":["Population Health Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/pop.2020.0036","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pop.2020.0036","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/pop.2020.0036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T01:24:37Z","timestamp":1777685077000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/pop.2020.0036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1089\/pop.2020.0036"],"URL":"https:\/\/doi.org\/10.1089\/pop.2020.0036","relation":{},"ISSN":["1942-7891","1942-7905"],"issn-type":[{"value":"1942-7891","type":"print"},{"value":"1942-7905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}