Use of Information Technology to Support Integration of Social Determinant of Health Services to Reduce Avoidable Emergency Department Visits
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 400
- 试验地点
- 2
- 主要终点
- Change in Adoption and Use of IT Platform
研究概览
简要总结
Working through regional Accountable Care Organizations (ACO) the sponsor will establish a 2-year pilot project to demonstrate that early recognition and intervention in the various Social Determinant of Health (SDoH) domains can reduce avoidable Emergency Department (ED) visits by high utilizers. The regional ACO's will contract with Medicaid Managed Care Plans to assign traditional high ED utilizing members to the pilot project. Members will be offered enhanced peer facilitated care management services connecting members with available SDoH community based services. Members fitting our eligibility criteria will self-select by way of completing a pilot project consent form.
详细描述
The project employs a two level intervention to include Peer Support Specialist (PSS) and Community Health Advocate (CHA). Contact and engagement with participating members will be through both direct intervention in the emergency department by Peer Support Specialist (the peer) as well as in the community for prevention visits and follow up by both the peer and Community Health Advocate. These well-positioned Peers and Community Health Advocates will address Behavioral and Social Determinants of Health (SDoH) concerns through a highly coordinated intervention supported by a common IT Medicaid member tracking platform. This research project will determine the feasibility of deploying a single shared IT platform that will include referral, appointment completion, and intervention outcome data. Project staff will develop a trusting relationship with the members and will improve member access and engagement with community-based services. The project will also seek to determine the impact on total cost of care through redirecting study participants to community resources that are more appropriate, and less expensive than return visits to the emergency department.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults age 18 to 65
- •New York State Medicaid Managed Care Members
- •Have utilized emergency department services 6 or more times in a 12-month period
- •Have been assigned to the Pilot Project by their Medicaid Managed Care Plan
排除标准
- •Individuals not assigned by a Managed Care Organization meeting the above criteria
研究组 & 干预措施
Medicaid Emergency Department High Utilizers
This Arm will include the following individuals
- Up to 400 Adults age 18 to 65
- New York State Medicaid Managed Care Members
- Have utilized emergency department services 6 or more times in a 12-month period
- Have been assigned to the Pilot Project by their Medicaid Managed Care Plan
干预措施: Peer Integrated Care Services (Behavioral)
结局指标
主要结局
Change in Adoption and Use of IT Platform
时间窗: Months 6, 12, 18, 24
Change in Number of Participating Agencies That Contribute Data to the IT System
Change in Total Cost of Care for Participating Members
时间窗: Month 0, Month 24
Change in cost trend for participating members. Pre-study vs. study period.
Change in Engagement of Medicaid Member Participants with Peer Integration Care Services
时间窗: Months 0, 3, 6, 9, 12, 15, 18, 21, 24
The change in acceptance by Medicaid Members of Peer Integrated Care Services
次要结局
- Change in Emergency Room Visits by Participating Members(Month 0, 6, 12,18,24)