Health Care Hotspotting: A Randomized Controlled Trial

NCT02090426 | Completed Results

• 1 other identifier: JPAL-763
• Study Type: interventional
• Target: 800
• Locations: 1 country
• Sites: 2

Brief Summary

This trial investigates the value created by the highly innovative Camden Coalition of Healthcare Providers' Care Management Program: Link2Care. The program targets "super-utilizers" of the health care system - specifically adults with 2 or more hospitalizations in the last six months 2 or more chronic conditions, and 5 or more outpatient medications - with intensive case management services. In particular, a team of nurses, social workers, community health workers and health coaches, supported by real-time data of healthcare utilization, perform home visits, accompany patients to doctor visits, and help patients enroll in social-service programs. This approach aims to improve the self-sufficiency of patients in navigating the healthcare and social-service systems and has the potential to reduce healthcare costs and improve patient health.

Conditions

High Utilizers of Hospital Care

Outcome Measures

Primary Outcomes (1)

• Any Hospital Readmission

  180-day from indexed hospital discharge

Secondary Outcomes (9)

• Any Emergency Department Use

  180-day from indexed hospital discharge

• Any Hospital Use (Inpatient or ED)

  180-day from indexed hospital discharge

• Inpatient Readmission From the ED

  180-day from indexed hospital discharge

• Inpatient Readmission Not From the ED

  180-day from indexed hospital discharge

• Number of Readmissions

  180-day from indexed hospital discharge

Other Outcomes (9)

• Number of Readmissions

  30-day from indexed hospital discharge

• Number of Readmissions

  90-day from indexed hospital discharge

• Number of Readmissions

  365-day from indexed hospital discharge

Study Arms (2)

Standard Care

NO INTERVENTION

Individuals in the standard care arm receive standard discharge planning from the hospital with no followup by Link2Care team members.

Link2Care

EXPERIMENTAL

Participants are assigned to a multidisciplinary care team (Link2Care) comprised of a registered nurse, licensed practical nurse, social worker, intervention specialist, community health worker, and health coaches. A representative from the care team engages with the patient at bedside during the hospital admission and plans for the immediate period following discharge. The Program, as a whole, involves a series of home visits, scheduling of and accompaniment to initial primary care and specialty care visits, and support for individuals as they navigate various social service agencies to enroll in public programs including TANF, SNAP, and programs that promote housing stability.

Other: Link2Care

Interventions

Link2Care OTHER

Link2Care

Eligibility Criteria

• Age: 19 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients must satisfy the following criteria based on the records from the index event:
• Is currently admitted to Cooper or Lourdes hospitals (still in hospital for recruitment)
• Resides in the following zip codes: 08101 (PO zip code), 08102-08105, 08107s, 08110
• Is 19-80 years old
• Has \>=2 hospital admissions in the past 6 months (to Camden area hospitals in the Health Information Exchange )
• Has \>=2 chronic conditions
• Patients must meet at least three of the following criteria based largely on the electronic medical record:
• Has \>=5 outpatient medications
• Has difficulty accessing services
• Lacks social support
• Has mental health co-morbidity
• Is actively using drugs
• Is homeless

You may not qualify if:

• Already subject in RCT (treatment or control)
• Deceased or discharged prior to triage or recruitment
• Uninsured
• Cognitively impaired
• Oncology patient
• Index hospitalization is for: a surgical procedure for an acute problem, complications of a progressive chronic disease with limited treatments, or mental health issue only with no co-morbid conditions

Sponsors & Collaborators

• Abdul Latif Jameel Poverty Action Lab: lead
• The Cooper Health System: collaborator
• National Bureau of Economic Research, Inc.: collaborator
• Massachusetts Institute of Technology: collaborator
• Harvard University: collaborator

Study Sites (2)

Cooper University Hospital

Camden, New Jersey, 08103, United States

Location

Our Lady of Lourdes Medical Center

Camden, New Jersey, 08103, United States

Location

Related Publications (2)

• Yang Q, Wiest D, Davis AC, Truchil A, Adams JL. Hospital Readmissions by Variation in Engagement in the Health Care Hotspotting Trial: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2332715. doi: 10.1001/jamanetworkopen.2023.32715.

  PMID: 37698862 DERIVED

• Finkelstein A, Zhou A, Taubman S, Doyle J. Health Care Hotspotting - A Randomized, Controlled Trial. N Engl J Med. 2020 Jan 9;382(2):152-162. doi: 10.1056/NEJMsa1906848.

  PMID: 31914242 DERIVED

Results Point of Contact

• Title: Amy Finkelstein, PhD
• Organization: Massachusetts Institute of Technology

jgubb@mit.edu

6173246995

Study Officials

• Amy N Finkelstein, PhD

  The Abdul Latif Jameel Poverty Action Lab/MIT

  PRINCIPAL INVESTIGATOR

• Jeffery Brenner, MD

  The Cooper Health System

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

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 17, 2014
• First Posted: March 18, 2014
• Study Start: June 2, 2014
• Primary Completion: October 1, 2018
• Study Completion: January 1, 2020
• Last Updated: November 19, 2020
• Results First Posted: March 11, 2020

Record last verified: 2020-10

Locations

US (2)