Connecting Low-Income Adults to Primary Care After Inpatient Discharge

Sponsor

Vanderbilt University Medical Center (Other)

Overall Status

Recruiting

CT.gov ID

NCT05567224

Collaborator

(none)

200

Enrollment

Location

45.5

Anticipated Duration (Months)

4.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Healthcare systems and insurers have tried to reduce costs by improving the care and coordination provided to patients with high healthcare spending. Often termed, "hotspotting", these interventions seek to lower costs by reducing care provided in fragmented, high-cost settings, including the emergency department and inpatient settings, by addressing the social determinants of health and improving patients' access to lower-cost, ambulatory settings. Vanderbilt University Medical Center (VUMC), in collaboration with Tennessee's Medicaid agency (TennCare), is piloting a program to reduce costs and improve the quality of care provided to high-risk TennCare enrollees by referring them from inpatient settings to VUMC primary care services. This study seeks to evaluate this pilot by comparing outcomes between Medicaid patients referred to VUMC primary care services and similar Medicaid patients not referred to VUMC primary care services using data from surveys and administrative sources, including electronic health records and health insurance claims.

Condition or Disease	Intervention/Treatment	Phase
Health Care Utilization Health Care Seeking Behavior	Other: Access to primary care services

Study Design

Study Type:

Observational

Anticipated Enrollment :

200 participants

Observational Model:

Other

Time Perspective:

Prospective

Official Title:

Connecting Low-Income Adults to Primary Care After Inpatient Discharge

Actual Study Start Date :

Dec 15, 2022

Anticipated Primary Completion Date :

Dec 1, 2024

Anticipated Study Completion Date :

Oct 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Pilot Group This group of TennCare recipients will be referred to VUMC primary care services and will be allowed to utilize these services for at least two years. Those referred to VUMC primary care services will be those who belong to the two of state's three Medicaid Managed Care plans who have agreed to participate in this pilot.	Other: Access to primary care services Those in the pilot group will be referred to primary care services and allowed to utilize them for at least two years. Primary care services include access to a primary care physician, medical management, and other tasks typically performed by a general practitioner. Those referred to primary care services will not have access to other VUMC outpatient services.
Control Group This group of TennCare recipients will not be referred to VUMC primary care services and will receive care as usual. Those not referred to VUMC primary care services will be those who belong to one of the state's three Medicaid Managed Care plans who has not agreed to participate in this pilot.

Arm

Intervention/Treatment

Pilot Group

This group of TennCare recipients will be referred to VUMC primary care services and will be allowed to utilize these services for at least two years. Those referred to VUMC primary care services will be those who belong to the two of state's three Medicaid Managed Care plans who have agreed to participate in this pilot.

Other: Access to primary care services

Those in the pilot group will be referred to primary care services and allowed to utilize them for at least two years. Primary care services include access to a primary care physician, medical management, and other tasks typically performed by a general practitioner. Those referred to primary care services will not have access to other VUMC outpatient services.

Control Group

This group of TennCare recipients will not be referred to VUMC primary care services and will receive care as usual. Those not referred to VUMC primary care services will be those who belong to one of the state's three Medicaid Managed Care plans who has not agreed to participate in this pilot.

Outcome Measures

Primary Outcome Measures

Number of Inpatient Admissions [30, 60, 90, 180, and 360 days]
How many times the participant is hospitalized within the specified time period

Secondary Outcome Measures

Number of Emergency Department Visits [30, 60, 90, 180, and 360 days]
How many times the participant presents to the emergency department within the specified time period
Number of Primary Care Visits [30, 60, 90, 180, and 360 days]
How many times the participant has seen a primary care physician within the specified time period
Average Health Care Spending [30, 60, 90, 180, and 360 days]
Health care expenditures by the patient within the specified time frame
Average Self-reported Health Status [30, 60, 90, 180, and 360 days]
A measure of the patient's self-reported physical and mental health, as measured by a shorter, modified version of the Short Form (SF)-36
Average of Disease Specific Outcomes [30, 60, 90, 180, and 360 days]
Depending on the clinical information that is captured, disease specific clinical outcomes (e.g. prevalence of hypertension; HbA1C levels) will also be reported

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age 18 or older
Currently enrolled in Tennessee's Medicaid Program (TennCare)
Presenting in VUMC's inpatient setting
Reporting no active relationship with a primary care doctor
Lives in Davidson County, Tennessee, or a surrounding county

Exclusion Criteria:

Patients discharged to a setting other than the community (e.g. to a Skilled Nursing Facility)

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Vanderbilt University Medical Center	Nashville	Tennessee	United States	37232

Sponsors and Collaborators

Vanderbilt University Medical Center

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Melinda Buntin, Mike Curb Professor and Chair, Department of Health Policy, Vanderbilt University Medical Center

ClinicalTrials.gov Identifier:

NCT05567224

Other Study ID Numbers:

221128

First Posted:

Oct 5, 2022

Last Update Posted:

Jan 26, 2023

Last Verified:

Jan 1, 2023

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD:

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Melinda Buntin, Mike Curb Professor and Chair, Department of Health Policy, Vanderbilt University Medical Center

Health Care Costs

Hospitalizations

Emergency Department Use

Health Care Accessibility

Medicaid

Low-income populations

Study Results

No Results Posted as of Jan 26, 2023