IT to Support Integration of Social Determinant of Health Services to Reduce Avoidable Emergency Department Visits

• ClinicalTrials.gov Identifier: NCT04125433
• Recruitment Status: Unknown
• First Posted: October 14, 2019
• Last Update Posted: October 14, 2019
• Sponsor: Northern New York Rural Behavioral Health Institute
• Information provided by (Responsible Party): Northern New York Rural Behavioral Health Institute

Study Description

Brief Summary:

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.

Condition or disease	Intervention/treatment	Phase
Mental Health Issue; Substance Use Disorders	Behavioral: Peer Integrated Care Services	Not Applicable

Detailed Description:

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.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 400 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Intervention Model Description: In this study a Medicaid Managed Care Plan will identify up to 400 plan members who have visited an emergency department greater than 6 time in a 12-month period. These individuals will receive enhanced integrated peer care services and will be tracked across health and social service venues using a single IT platform. This study will examine the impact of this intervention on total cost of care.
• Masking: None (Open Label)
• Primary Purpose: Supportive Care
• Official Title: Use of Information Technology to Support Integration of Social Determinant of Health Services to Reduce Avoidable Emergency Department Visits
• Estimated Study Start Date: August 1, 2020
• Estimated Primary Completion Date: June 30, 2022
• Estimated Study Completion Date: August 30, 2022

Arms and Interventions

Arm

Intervention/treatment

Experimental: 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

Behavioral: Peer Integrated Care Services; 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 as well as in the community for prevention visits and follow up. Peers and Community Health Advocates will address Behavioral and Social Determinants of Health (SDoH) concerns through a 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 relationship with the members improving member access and engagement with community-based services. The project will determine the impact on total cost of care through redirecting study participants to community resources rather than return visits to the emergency department.

Outcome Measures

Primary Outcome Measures :

1. Change in Adoption and Use of IT Platform [ Time Frame: Months 6, 12, 18, 24 ]
   Change in Number of Participating Agencies That Contribute Data to the IT System
2. Change in Engagement of Medicaid Member Participants with Peer Integration Care Services [ Time Frame: Months 0, 3, 6, 9, 12, 15, 18, 21, 24 ]
   The change in acceptance by Medicaid Members of Peer Integrated Care Services
3. Change in Total Cost of Care for Participating Members [ Time Frame: Month 0, Month 24 ]
   Change in cost trend for participating members. Pre-study vs. study period.

Secondary Outcome Measures :

1. Change in Emergency Room Visits by Participating Members [ Time Frame: Month 0, 6, 12,18,24 ]
   Change in rate of Emergency Department utilization by participating members.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• 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

Exclusion Criteria:

• Individuals not assigned by a Managed Care Organization meeting the above criteria

Contacts and Locations

Contacts

Contact: Barry Brogan, MAPP; 518-891-9460; barry@behaviorhealthnet.orh

Contact: Robert Cawley, BBA; 518-891-9460; robert@behaviorhealthnet.org

Locations

United States, New York

Northern New York Rural Behavioral Health Institute

Saranac Lake, New York, United States, 12983

Contact: Barry Brogan, MAPP 518-891-9460 barry@behaviorhealthnet.org

Contact: Robert Cawley, BBA 518-891-9460 robert@behaviorhealthnet.org

Sponsors and Collaborators

Northern New York Rural Behavioral Health Institute

Investigators

• Principal Investigator: Robert Cawley, BBA; Northern NY Rural Behavioral Health Institute

More Information

• Responsible Party: Northern New York Rural Behavioral Health Institute
• ClinicalTrials.gov Identifier: NCT04125433
• Other Study ID Numbers: NCBHNPIC
• First Posted: October 14, 2019
• Last Update Posted: October 14, 2019
• Last Verified: October 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Emergencies; Substance-Related Disorders; Disease Attributes; Pathologic Processes; Chemically-Induced Disorders; Mental Disorders