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San Francisco Health Plan Care Support Trial (SFHP_CBCM)

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ClinicalTrials.gov Identifier: NCT02463838
Recruitment Status : Completed
First Posted : June 4, 2015
Last Update Posted : January 15, 2019
Sponsor:
Collaborators:
San Francisco Health Plan
California Health Facilities Financing Authority (CHFFA)
Information provided by (Responsible Party):
Maria Raven, MD, University of California, San Francisco

Brief Summary:
This study will expand and evaluate an existing pilot program to improve care for frequent users of acute emergency and inpatient services by providing care coordination and management for eligible San Francisco Health Plan members. SF Health Plan's Community-Based Care Management pilot program ("Program") known as "CareSupport" serves vulnerable SF Health Plan members who are high utilizers of hospital inpatient and emergency departments and at extremely high risk for mortality and morbidity due to factors such as housing instability, mental illness, and addiction. Care managers, called community coordinators, are trained bachelor-level social workers or outreach workers and each have a panel of 30-35 members who they directly engage in the community where the members tend to live or congregate (shelters, bus stops, coffee shops, community agencies, and by cell phone) to help them improve their health and navigate through the health care and social services systems. The number of San Francisco Health Plan members who would be eligible for Care Support services far outstrips the capacity the San Francisco Health Plan to provide these additional services, and the investigators will thus evaluate the intervention using a randomized trial design.

Condition or disease Intervention/treatment Phase
Case Management Managed Care Program Other: Care Support Intervention Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 292 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: San Francisco Health Plan Care Support Intervention: A Randomized Trial
Actual Study Start Date : May 2015
Actual Primary Completion Date : December 2018
Actual Study Completion Date : December 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Care Support Intervention
Eligible members are assigned a CareSupport Coordinator who carries a caseload of 25-35 members. A team of 5 Coordinators is supervised by a master's level Social Worker. Community Coordinators work with members to conduct standardized assessments to develop a Care Plan shared with other providers within and outside of SFHP. Coordinators provide members advocacy and navigation across systems of care, to improve coordination focus on treatment goals. Coordinator focus on prevention and early intervention around disease management, advocacy, appointment reminders and accompaniment, home visits, and regular communication with primary care and other providers. Coordinators are encouraged to be accountable for coordinating and following through on all aspects of a member's needs.
Other: Care Support Intervention
Case management and care coordination intervention delivered in person to SFHP members who are frequent users of emergency department and inpatient hospital services.

No Intervention: Usual Care
All eligible SFHP members randomized to usual care will receive medical and health plan by virtue of enrollment in the SFHP and Medi-Cal. Services include assignment to a primary care physician and access to all services available through Medi-Cal in the county of San Francisco.



Primary Outcome Measures :
  1. ED visits [ Time Frame: 9-18 months ]
    Difference in the number of ED visits comparing intervention and usual care groups

  2. Hospital admissions [ Time Frame: 9-18 months ]
    Difference in the number of hospital admissions comparing intervention and usual care groups

  3. Hospital bed days [ Time Frame: 9-18 months ]
    Difference in the number of hospital bed days comparing intervention and usual care groups


Secondary Outcome Measures :
  1. Primary care visits [ Time Frame: 9-18 months ]
    Difference in the number of primary care visits comparing intervention and usual care groups

  2. Cost of health care services [ Time Frame: 9-18 months ]
    Difference in costs associated with ED visits, hospital admissions, and primary care visits comparing intervention and usual care groups, using standard Medi-Cal reimbursement rates

  3. Net program costs [ Time Frame: 9-18 months ]
    Comparative cost analysis that examines differences in Medi-Cal reimbursements in comparison to SFHP program costs (e.g. staffing, overhead). we plan to track not only the health service use costs outlined above (by assigning standard Medi-Cal reimbursement rates to each service), but also costs related to the CareSupport program such as staffing costs, supplies, and transportation via a comprehensive economic analysis.

  4. Mental health [ Time Frame: Baseline, 6 month follow-up, 12 month follow up if still enrolled ]
    Depression will be evaluated for the intervention group only, and will include depression based on the PHQ-2. Changes in scores will be assessed at baseline and 6-month follow-up as a standard part of the CareSupport assessment and follow-up process conducted by the CareSupport Community Coordinators.

  5. Patient satisfaction [ Time Frame: Baseline, 6 month follow-up, 12 month follow up if still enrolled ]
    Satisfaction will be evaluated for the intervention group only, and will include depression based on the PHQ-9. Changes in scores will be assessed at baseline and 6-month follow-up as a standard part of the CareSupport assessment and follow-up process conducted by the CareSupport Community Coordinators.

  6. Self-reported health [ Time Frame: Baseline, 6 month follow-up, 12 month follow up if still enrolled ]
    Self reported health will be evaluated for the intervention group only and will include a question from the SF-8.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

To be eligible, SFHP members must have one of three health service use patterns in the prior 12 months:

  • 2 or more hospital admissions
  • 5 ED visits and 1 hospital admission
  • 6 or more ED visits
  • Must be aged 18 or older

Exclusion Criteria:

  • Under age 18
  • Not a SFHP member

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02463838


Locations
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United States, California
San Francisco Health Plan
San Francisco, California, United States, 94105
Sponsors and Collaborators
University of California, San Francisco
San Francisco Health Plan
California Health Facilities Financing Authority (CHFFA)

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Responsible Party: Maria Raven, MD, Assistant Professor of Emergency Medicine, University of California, San Francisco
ClinicalTrials.gov Identifier: NCT02463838     History of Changes
Other Study ID Numbers: 14-14737
First Posted: June 4, 2015    Key Record Dates
Last Update Posted: January 15, 2019
Last Verified: January 2019

Keywords provided by Maria Raven, MD, University of California, San Francisco:
Medi-Cal
Health Plan
Frequent Users
Heavy users
Care Coordination
Managed Care
Case Management
Mental Health
Substance Use
Emergency Department