Repisodic & Skilled Nursing Facility Preferred Provider Networks

NCT04263779 | Completed

• 1 other identifier: 2019-1101
• Study Type: interventional
• Target: 5,581
• Locations: 1 country
• Sites: 1

Brief Summary

This study tests whether changing the relative order of presentation of post acute care skilled nursing facilities (SNFs) in the Repisodic application, i.e., presenting preferred SNFs (P-SNFs) first, increases selection of, and discharges to, P-SNFs and decreases lengths of stay (LoS) for Geisinger patients discharged to SNFs. Along with the order of P-SNFs, the study also assesses whether a short video reviewing the benefits of care coordination in P-SNFs increases patient election to transfer to one.

Conditions

Skilled Nursing Facilities; Behavioral Economics

Keywords

Default Options; Order of Options; Choice Architecture; Video; Decision Aid; Mobile Application

Outcome Measures

Primary Outcomes (8)

• Overall LoS (system/case manager level)

  Difference in LoS (in days) for patients as a function of case manager study condition.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF placement (system/case manager level)

  Difference in proportion of discharges of patients to P-SNFs (out of P-SNFs + NP-SNFs) as a function of case manager study condition.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF pre-selection (case manager level)

  Number of P-SNFs selected by case managers for inclusion in the patients' lists, to assess the direct impact of Repisodic changes on case manager behavior; this is the first decision in the process, before patients' selections and SNF availability factor into the final discharge decision and placement.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF selection (case manager level)

  Number of P-SNFs selected by patients to help assess the downstream impact of Repisodic changes on patient behavior following case manager pre-selection, again omitting the influence of SNF availability.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF percent selected (case manager level)

  Percentage of patients who selected at least one P-SNF, to help assess the downstream impact of Repisodic changes on patient behavior following case manager pre-selection.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• LoS (patient/caretaker level)

  LoS for patients (in days).

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF placement (patient/caretaker level)

  Patient was discharged to a P-SNF: yes/no.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF selection (patient/caretaker level)

  Patient selected a P-SNF for discharge: yes/no. This is a more direct reflection of patient behavior, not yet moderated by bed availability and other real-world considerations that affect Outcome 7.

  24 months or as long as it takes to reach N=5,000, whichever occurs first

Secondary Outcomes (2)

• Time to pre-select a SNF (case manager level)

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• Time to select a SNF (patient/caretaker level)

  24 months or as long as it takes to reach N=5,000, whichever occurs first

Other Outcomes (3)

• LoS for patients who had a P-SNF as an option (patient/caretaker level)

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF placement for patients who had a P-SNF as an option (patient/caretaker level)

  24 months or as long as it takes to reach N=5,000, whichever occurs first

• P-SNF selection for patients who had a P-SNF as an option (patient/caretaker level)

  24 months or as long as it takes to reach N=5,000, whichever occurs first

Study Arms (4)

Default List (case manager level)

NO INTERVENTION

In this condition, all SNF options will be presented to case managers in Repisodic in rank order according to Repisodic's algorithm that weights dimensions such as Centers for Medicare \& Medicaid Services (CMS) quality metric ratings, distance, and the match between SNF features and specific patient need. The list only includes SNFs that accept the patient's insurance.

P-SNF Top-Sorted List (case manager level)

EXPERIMENTAL

This condition is the same as the Default List, except that relevant providers (i.e., those meeting patient needs and located within a threshold distance to be determined per hospital) who are part of the Geisinger preferred provider network will be presented at the top of the otherwise ranked list of SNFs. Situations in which there are no relevant P-SNFs will be flagged yet still assigned to this condition, in an intent-to-treat analysis; the default algorithm-based rank-ordered approach will be applied to all non-preferred providers.

Behavioral: Order of Options

Full List/Full Map/Default Video (patient level)

NO INTERVENTION

All SNF options, both P-SNFs and NP-SNFs (up to a maximum of 10 by default) that case managers preselected for patients will be presented to patients in rank order (according to Repisodic's algorithm, as described above). Patients will also have the option of viewing the default Repisodic map, which will show the SNFs on the list, and patients will be provided the link to an introductory video presenting the SNF selection and discharge process. When only a paper printout is available, the same SNF sorting order will be presented on paper.

P-SNF List/P-SNF Map/P-SNF Video (patient level)

EXPERIMENTAL

This is the same as the Full List condition, except that both the list and the map will present only the P-SNFs, with a button allowing patients to view all results only if they opt to do so. Moreover, the link to viewing the optional introductory video will be highlighted, and the video will include sections describing the advantage of P-SNFs for care coordination. When only a paper printout is available, the same SNF sorting order will be presented on paper, with only the P-SNFs presented on the first page.

Behavioral: Default Option

Interventions

Order of Options BEHAVIORAL

Relevant providers who are part of the Geisinger preferred provider network will be presented at the top of the otherwise ranked list of SNFs.

Also known as: Choice Architecture

P-SNF Top-Sorted List (case manager level)

Default Option BEHAVIORAL

Both the list and the map will present only the P-SNFs, with a button allowing patients to view all results only if they opt to do so. The optional P-SNF advantage video will be included and the link to it highlighted.

Also known as: Order of Options, Choice Architecture

P-SNF List/P-SNF Map/P-SNF Video (patient level)

Eligibility Criteria

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

You may qualify if:

• Discharging units at Geisinger (e.g., Geisinger Medical Center, Geisinger Wyoming Valley Medical Center, and Geisinger Community Medical Center)
• Patients placed on adult medical/surgical wards
• Patients selected for discharge to a SNF
• Case managers using Repisodic to discharge patients (under the criteria above) to a SNF
• Discharge date occurs after pandemic alleviation benchmark has been met (see Study Description for further details)

You may not qualify if:

• Discharges in which the full list presented to the case manager contains no P-SNFs.
• Note: If a patient consistent with the above criteria has a caretaker that is interacting with the Repisodic application for the patient's post-acute care decision, the caretaker's behavior will be used.

Sponsors & Collaborators

• Geisinger Clinic: lead

Study Sites (1)

Geisinger

Danville, Pennsylvania, 17822, United States

Location

Study Officials

• Amir Goren, PhD

  Geisinger Clinic

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Participants (i.e., patients/caretakers and case managers) will not be informed specifically of their assignment to different arms throughout the study, but case managers will be informed that Repisodic is continuing to undergo development and testing and that they may therefore notice different patients and colleagues receiving slightly different versions of Repisodic over time.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Program Director, Behavioral Insights Team

Model Details: Case managers (\~145) will be randomly assigned to conditions in a cluster-randomized trial design: 1. Default List: all eligible SNF options presented in Repisodic in rank order. 2. P-SNF Top-Sorted List: same as Default List, except relevant P-SNFs will be shown at the top of the otherwise ranked list. Patients (\~5,000) will independently be randomized to conditions and tracked: 1. Full List/Full Map/Default Video: all SNF options preselected by case managers will be presented to patients ordered by Repisodic's ranking algorithm. A map will present SNFs on the list if selected, and a link to an introductory video on SNF selection and discharge will be available. 2. P-SNF List/P-SNF Map/P-SNF Video: same as Full List, except that both the list and map will present only the P-SNFs, with an opt-in button allowing patients to view all results. Moreover, the link to view the optional SNF video will be highlighted and the advantage of P-SNFs for care coordination will be presented.

Study Record Dates

• First Submitted: February 7, 2020
• First Posted: February 11, 2020
• Study Start: May 28, 2021
• Primary Completion: January 2, 2023
• Study Completion: January 2, 2023
• Last Updated: March 2, 2023

Record last verified: 2023-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
• Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.

Locations

US (1)