A Comprehensive Disease Management Program for Medically-Complex Substance Users

Not Applicable

Withdrawn

• Conditions: Substance-related Disorder
• Interventions: Behavioral: Contingency Management; Other: Case management

• Registration Number: NCT00865956
• Lead Sponsor: Johns Hopkins University

Brief Summary

Disease management (DM) programs are being increasingly utilized by health plans to coordinate care, improve quality of care, and control costs in chronically ill individuals. DM programs for specific medical conditions, such as diabetes mellitus, congestive heart failure, and asthma, have demonstrated improvements in health outcomes and a number of studies have found economic benefits to these programs as well. There are fewer data evaluating multi-disease DM programs, and results have been mixed. Additionally, data on such programs specifically targeting substance-using populations are limited, although they are promising. Prior utilization and hospitalization data from Johns Hopkins Hospital, Johns Hopkins Health Care, and Priority Partners Managed Care Organization (PPMCO) suggest that a substantial portion of high-utilizing, high-cost, medically complex patients have a substance use diagnosis.

The investigators hypothesize that a comprehensive DM program for medically-complex substance users with a history of hospitalization, consisting of intensive nurse case management along with behavioral incentives to reinforce engagement in primary care, can decrease inpatient days and costs, as well as improve outcomes for substance use, depression, and physical and mental functioning. The investigators will compare the case management/behavioral incentives intervention to usual care among a group of medically-complex, substance-using, PPMCO enrollees. Usual care will include access to all existing Priority Partners care management programs, and usual The investigators believe that this research will make an important contribution to the development of models of chronic care that improve health and promote the best use of health care resources. Additionally, the investigators believe this project will promote the study and development of systems to improve the health of substance-using adults, an underserved and often marginalized group.

Detailed Description

Not available

Study Timeline

• Study Start: 2008-03
• Study First Submitted: 2009-03-19
• Study First Submitted QC: 2009-03-19
• Study First Posted: 2009-03-20
• Primary Completion: 2010-06
• Study Completion: 2010-06
• Status Verified: 2018-10
• Last Update Submitted: 2018-10-08
• Last Update Posted: 2018-10-10

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• Age over 18
• Continuous enrollment in Priority Partners MCO for past 12 months
• Primary care site East Baltimore Medical Center (EBMC)
• PPMCO substance abuse flag other than nicotine only within past 24 months

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Exclusion Criteria

• currently enrolled in PPMCO Care Management

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Care Management	Case management	Care Management plus voucher incentives for adherence to primary care appointments.
Care Management	Contingency Management	Care Management plus voucher incentives for adherence to primary care appointments.

Primary Outcome Measures

Name	Time	Method
Per member per month expenditures	12 months

Secondary Outcome Measures

Name	Time	Method
Depression	12 months
Hospitalization days	12 months
Outpatient visits	12 months
Emergency Department visits	12 months
Substance use disorder treatment	12 months
Self-reported substance use	12 months
Physical and mental functioning	12 months

Trial Locations

Locations (1)

East Baltimore Medical Center; 🇺🇸 Baltimore, Maryland, United States