Using Data Analytics and Targeted Whole Health Coaching to Reduce Frequent Utilization of Acute Care Among Homeless Veterans
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 177
- 试验地点
- 3
- 主要终点
- Days of all-cause hospitalization
研究概览
简要总结
Use of acute care services (e.g., hospitalizations, Emergency Department visits) contributes substantially to the cost of healthcare for Veterans. Homelessness is a robust social determinant of super utilization of acute care. The goal of this project is to test if Peer Specialists trained in Whole Health Coaching can reduce homeless Veterans' frequent use of acute care.
详细描述
Ten percent of patients account for up to 70% of acute care costs. Among these "super-utilizer" patients, homelessness is a robust social determinant of acute care utilization. Through a field-based dashboard and clinical aids, the Hot Spotter Analytic program assists Patient Aligned Care Teams (PACT) with targeting and tailoring care for the highest-need homeless Veterans. However, many Veterans identified by the Analytics do not engage in supportive services that reduce risk for acute care utilization. Peer Specialists (PS) are a high-value workforce that can facilitate Veterans' engagement in care. Yet, there is a need to enhance the PS role with a structured approach that can capitalize on known facilitators of care engagement among homeless Veterans. Whole Health Coaching (WHC) is one such approach. By focusing on patients' values and goals rather than treatment of specific conditions, WHC reduces patients' stigma regarding their care needs and increases patient activation and well-being, which can increase engagement in supportive services.
The goal of this project is to integrate use of Hot Spotter Analytics with Peer Specialists trained in Whole Health Coaching (PS-WHC) and evaluate whether this approach reduces homeless Veterans' frequent use of acute care. Using a Hybrid Type 1 design at the Palo Alto, Bedford, and North Little Rock VAs, the investigators will test whether receipt of PS-WHC (vs. Enhanced Usual Care; EUC) predicts (1a) lower acute care utilization, (1b) better health-related outcomes, and whether (1c) the effects of PS-WHC on 1a and 1b are mediated by increased (i) patient activation and well-being, and (ii) access to supportive services. Aim 2: Conduct a process evaluation to inform VA's potential widespread implementation of Hot Spotter Analytics + PS-WHC on PACTs. Aim 3: Conduct a Budget Impact Analysis to determine the impact on total costs of VA care due to implementing PS-WHC.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Veterans who:
- •are on VA's Homeless Registry, which comprises those who utilized any VA homeless programs and services in the past 2 years
- •are enrolled on a Patient Aligned Care Team (or "PACT") at a study site
- •had a hot spotter qualifying event in two or more quarters in the past year will be eligible for participation
排除标准
- •Veterans who have a suicidal and/or behavioral flag in their medical record and those who are too cognitively impaired to understand the informed consent process and other study procedures will be excluded
研究组 & 干预措施
Peer Specialist - Whole Health Coaching (PS-WHC)
Participants will meet with a Peer Specialist for 18 sessions over 24 weeks. The essential elements of this intervention include 1) general support provided via the core functions of a Peer Specialist, and 2) a structured Whole Health Coaching curriculum.
干预措施: Peer Support-Whole Health Coaching (Behavioral)
Enhanced Usual Care (EUC)
Usual PACT care plus Hot Spotter Analytics (consists of access to field-based dashboard that allows PACTS to identify homeless Veterans on their panels who were super-utilizers, and the hot spotter manual).
结局指标
主要结局
Days of all-cause hospitalization
时间窗: 9 months (post-baseline)
Data on all-cause hospitalization (medical/surgical, substance use, and mental health) (bed days of care) will be obtained from the CDW Inpatient and Outpatient files. VA-paid acute care at non-VA facilities will also be searched in the Fee Basis and Program Integrity Tool (PIT) files, including "Choice" care.
次要结局
- Perceptions of Health (PROMIS-10)(9 months (post-baseline))
- Percent Days Homeless(9 months (post-baseline))
- Substance Use(9 months (post-baseline))
- Depression (PHQ-9)(9 months (post-baseline))
- PTSD (PCL-5)(9 months (post-baseline))
- Days of mental health hospitalizations(9 months (post-baseline))
- Patient Engagement (ACE)(9 months (post-baseline))
- Peer service engagement(9 months (post-baseline))
- ED visits(9 months (post-baseline))
- Alcohol Use Problems (AUDIT)(9 months (post-baseline))
- Days of Ambulatory Care Sensitive Condition (ACSC) hospitalizations(9 months (post-baseline))
- Days of medical hospitalizations(9 months (post-baseline))
- Whole Health service engagement(9 months (post-baseline))