San Francisco Health Plan Care Support Trial

NCT02463838 | Completed

• 1 other identifier: 14-14737
• Study Type: interventional
• Target: 292
• Locations: 1 country
• Sites: 1

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.

Conditions

Case Management; Managed Care Program

Keywords

Medi-Cal; Health Plan; Frequent Users; Heavy users; Care Coordination; Managed Care; Case Management; Mental Health; Substance Use; Emergency Department

Outcome Measures

Primary Outcomes (3)

• ED visits

  Difference in the number of ED visits comparing intervention and usual care groups

  9-18 months

• Hospital admissions

  Difference in the number of hospital admissions comparing intervention and usual care groups

  9-18 months

• Hospital bed days

  Difference in the number of hospital bed days comparing intervention and usual care groups

  9-18 months

Secondary Outcomes (6)

• Primary care visits

  9-18 months

• Cost of health care services

  9-18 months

• Net program costs

  9-18 months

• Mental health

  Baseline, 6 month follow-up, 12 month follow up if still enrolled

• Patient satisfaction

  Baseline, 6 month follow-up, 12 month follow up if still enrolled

Study Arms (2)

Care Support Intervention

EXPERIMENTAL

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

Usual Care

NO INTERVENTION

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.

Interventions

Care Support Intervention OTHER

Case management and care coordination intervention delivered in person to SFHP members who are frequent users of emergency department and inpatient hospital services.

Care Support Intervention

Eligibility Criteria

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

You may qualify if:

• To be eligible, SFHP members must have one of three health service use patterns in the prior 12 months:
• or more hospital admissions
• ED visits and 1 hospital admission
• or more ED visits
• Must be aged 18 or older

You may not qualify if:

• Under age 18
• Not a SFHP member

Sponsors & Collaborators

• University of California, San Francisco: lead
• San Francisco Health Plan: collaborator
• California Health Facilities Financing Authority (CHFFA): collaborator

Study Sites (1)

San Francisco Health Plan

San Francisco, California, 94105, United States

Location

MeSH Terms

Conditions

Psychological Well-Being; Substance-Related Disorders; Emergencies

Condition Hierarchy (Ancestors)

Personal Satisfaction; Behavior; Chemically-Induced Disorders; Mental Disorders; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Emergency Medicine

Study Record Dates

• First Submitted: May 27, 2015
• First Posted: June 4, 2015
• Study Start: May 1, 2015
• Primary Completion: December 1, 2018
• Study Completion: December 1, 2018
• Last Updated: January 15, 2019

Record last verified: 2019-01

Locations

US (1)