THRIVE+ Pharmacy Liaison-Patient Navigation Intervention
- Conditions
- Healthcare Utilization
- Interventions
- Other: THRIVE screening and referralOther: Pharmacy Care Program servicesOther: Patient Navigation ServicesOther: Motivational InterviewingOther: Linkage to Community Partner Organization
- Registration Number
- NCT03919084
- Lead Sponsor
- Boston Medical Center
- Brief Summary
This is a pragmatic comparative effectiveness trial (n=364) to compare two screening and referral program models to address health-related social needs (HRSN) among the intermediate risk population of Boston Accountable Care Organization (BACO), a Medicaid ACO. The first study arm is THRIVE-Basic, the low-touch usual care model already implemented in all primary care clinics at Boston Medical Center (BMC) where patients are screened for HRSN and receive a printed paper resource referral guide. The second study arm is THRIVE+, which enhances the THRIVE-Basic model by engaging a pharmacy liaison-patient navigator to provide targeted navigation services and motivational interviewing to ensure connection to hospital- and community-based resources. The patient navigators will also interface directly with a partner community organization, Action for Boston Community Development (ABCD), to further help connect patients receiving THRIVE+ to community resources for HRSN. All patients in our study will receive pharmacy services via an existing Pharmacy Care Program. Patients in study arm 1 will be connected to a pharmacy liaison, which is standard clinical practice for intermediate risk ACO members in the BMC General Internal Medicine clinics. Patients in study arm 2 will receive systematic screening for and addressing of HRSN (THRIVE+) via a pharmacy liaison-patient navigator (a pharmacy technician trained as a patient navigator to deploy both pharmacy services and the THRIVE+ intervention), thereby avoiding duplication of services and multiple touches. Assignment to the study arms will be linked to existing Pharmacy Care Program enrollment activities and will be based on medical record number. The investigators' rationale for the study is that if patients' HRSN are addressed, patients will be better positioned to manage chronic conditions, adhere to preventive care plans, and less likely to use the emergency department (a conduit to inpatient care) for ambulatory care-sensitive conditions. The effectiveness of these two models will be compared with respect to alleviating HRSN and reducing acute health care utilization over a 12-month follow-up period.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 364
- Identified as within the 3rd to 10th percentile for healthcare utilization and cost among Boston Accountable Care Organization (BACO) Medicaid ACO membership at the time of enrollment in the clinical program; and
- Attend a primary care visit with a primary care provider (PCP-nurse practitioner or physician) in General Internal Medicine at Boston University Medical Center.
-Patients who are receiving services from the BACO complex care management program.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description THRIVE+ Motivational Interviewing Enhanced screening-and-referral with motivational interviewing and patient navigation services THRIVE+ Linkage to Community Partner Organization Enhanced screening-and-referral with motivational interviewing and patient navigation services THRIVE-Basic THRIVE screening and referral Screening-and-referral usual care model THRIVE-Basic Pharmacy Care Program services Screening-and-referral usual care model THRIVE+ Patient Navigation Services Enhanced screening-and-referral with motivational interviewing and patient navigation services THRIVE+ THRIVE screening and referral Enhanced screening-and-referral with motivational interviewing and patient navigation services THRIVE+ Pharmacy Care Program services Enhanced screening-and-referral with motivational interviewing and patient navigation services
- Primary Outcome Measures
Name Time Method Acute healthcare utilization composite measure 12 months Measure includes all-cause hospital admissions and all-cause emergency department visits.
- Secondary Outcome Measures
Name Time Method Number of 30-day emergency department revisits 12 months Total number of all-cause emergency department revisits within thirty (30) days of initial emergency department visit.
Number of all-cause emergency department visits 12 months Total number of all-cause emergency department visits.
Emergency department revisits rate 12 months Total number of all-cause emergency department revisits within thirty (30) days of initial emergency department visit divided by total number of all-cause emergency department visits.
Number of 30-day hospital readmissions 12 months Total number of all-cause discharges from inpatient status that had a subsequent admission within thirty (30) days of the initial discharge.
Number of all-cause hospital discharges 12 months Total number of all-cause discharges from inpatient status
30-day inpatient readmission rate 12 months Total number of all-cause discharges from inpatient status that had a subsequent admission within thirty (30) days of the initial discharge divided by total number of all-cause discharges from inpatient status.
Trial Locations
- Locations (1)
Boston Medical Center
🇺🇸Boston, Massachusetts, United States