A Comprehensive Disease Management Program for Medically-Complex Substance Users

NCT00865956 | Withdrawn

• 1 other identifier: NA_00015261
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Disease management (DM) programs are being increasingly utilized by health plans to coordinate care, improve quality of care, and control costs in chronically ill individuals. DM programs for specific medical conditions, such as diabetes mellitus, congestive heart failure, and asthma, have demonstrated improvements in health outcomes and a number of studies have found economic benefits to these programs as well. There are fewer data evaluating multi-disease DM programs, and results have been mixed. Additionally, data on such programs specifically targeting substance-using populations are limited, although they are promising. Prior utilization and hospitalization data from Johns Hopkins Hospital, Johns Hopkins Health Care, and Priority Partners Managed Care Organization (PPMCO) suggest that a substantial portion of high-utilizing, high-cost, medically complex patients have a substance use diagnosis. The investigators hypothesize that a comprehensive DM program for medically-complex substance users with a history of hospitalization, consisting of intensive nurse case management along with behavioral incentives to reinforce engagement in primary care, can decrease inpatient days and costs, as well as improve outcomes for substance use, depression, and physical and mental functioning. The investigators will compare the case management/behavioral incentives intervention to usual care among a group of medically-complex, substance-using, PPMCO enrollees. Usual care will include access to all existing Priority Partners care management programs, and usual The investigators believe that this research will make an important contribution to the development of models of chronic care that improve health and promote the best use of health care resources. Additionally, the investigators believe this project will promote the study and development of systems to improve the health of substance-using adults, an underserved and often marginalized group.

Conditions

Substance-related Disorder

Keywords

disease management; substance use disorders; behavioral incentives

Outcome Measures

Primary Outcomes (1)

• Per member per month expenditures

  12 months

Secondary Outcomes (7)

• Hospitalization days

  12 months

• Outpatient visits

  12 months

• Emergency Department visits

  12 months

• Substance use disorder treatment

  12 months

• Self-reported substance use

  12 months

Study Arms (2)

Care Management

EXPERIMENTAL

Care Management plus voucher incentives for adherence to primary care appointments.

Behavioral: Contingency Management; Other: Case management

Usual care

NO INTERVENTION

Usual care

Interventions

Contingency Management BEHAVIORAL

Rite Aid vouchers (stepped value) for reinforcement of adherence to primary care

Care Management

Case management OTHER

Nurse case manager assigned to participant

Care Management

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age over 18
• Continuous enrollment in Priority Partners MCO for past 12 months
• Primary care site East Baltimore Medical Center (EBMC)
• PPMCO substance abuse flag other than nicotine only within past 24 months

You may not qualify if:

• currently enrolled in PPMCO Care Management

Sponsors & Collaborators

• Johns Hopkins University: lead
• Johns Hopkins Community Physicians: collaborator

Study Sites (1)

East Baltimore Medical Center

Baltimore, Maryland, 21202, United States

Location

MeSH Terms

Conditions

Substance-Related Disorders

Interventions

Case Management

Condition Hierarchy (Ancestors)

Chemically-Induced Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Patient Care Planning; Comprehensive Health Care; Patient Care Management; Health Services Administration

Study Officials

• J Hunter Young, MD, MHS

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 19, 2009
• First Posted: March 20, 2009
• Study Start: March 1, 2008
• Primary Completion: June 1, 2010
• Study Completion: June 1, 2010
• Last Updated: October 10, 2018

Record last verified: 2018-10

Locations

US (1)