Wisconsin Evaluation of Emergency Department Care Coordination

NCT04550169 | Completed

• 5 other identifiers: 2020-1211MSN240705A538500SMPH/POP HEALTH SCI/POP HEALTHProtocol Version April 2020
• Study Type: observational
• Target: 3,405
• Locations: 1 country
• Sites: 4

Brief Summary

The State of Wisconsin is now expanding its investment in care coordination models as an effort to reduce inappropriate hospital emergency department (ED) use, improve health outcomes, and reduce Medicaid expenditures. This effort begins with a pilot program to support emergency department care coordination in hospitals and health systems that apply and are selected to participate in the pilot program. The Wisconsin Medicaid program seeks to understand whether this program achieves its intended goals and, specifically, whether the Medicaid payment for such care coordination services produces the intended program outcomes. Hospitals will select members that will receive care coordination services. In a quasi-experimental approach, the study team will compare members that do vs. do not receive the services will be used examine the effects of care coordination and referrals on total ED visits, primary-care treatable ED visits, non-emergent ED visits, and health care costs, as well as the specific effects of referring patients to providers who offer low-cost and after-hours care. To assess the importance of targeting, study team will conduct stratified analyses of vulnerable groups such as people with disabilities and individuals with specific clinical needs.

Conditions

Emergency Department Visit

Keywords

Medicaid; CARES (Wisconsin Client Assistance for Re-Employment and Economic Support)

Outcome Measures

Primary Outcomes (16)

• Total Number of Emergency Department Visits

  6 months

• Total Number of Emergency Department Visits

  12 months

• Total Number of Emergency Department Visits

  18 months

• Total Number of Emergency Department Visits

  24 months

• Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions

  6 months

• Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions

  12 months

• Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions

  18 months

• Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions

  24 months

• Cost to Medicaid for all Emergency Department Visits

  6 months

• Cost to Medicaid for all Emergency Department Visits

  12 months

• Cost to Medicaid for all Emergency Department Visits

  18 months

• Cost to Medicaid for all Emergency Department Visits

  24 months

• Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions

  6 months

• Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions

  12 months

• Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions

  18 months

• Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions

  24 months

Secondary Outcomes (13)

• Total Number of Primary Care Visits

  6, 12, 18, and 24 months

• Number of Participants Who Used Any Primary Care Visits

  6, 12, 18, and 24 months

• Number of Participants Who Used Specialty Care Visits

  6, 12, 18, and 24 months

• Total Number of Specialty Care Visits

  6, 12, 18, and 24 months

• Number of Participants with Any Hospitalizations

  6, 12, 18, and 24 months

Study Arms (2)

Intensive Care Coordination

Intensive Care Coordination along with Standard of Care

Other: Intensive Care Coordination

Control

Standard of Care alone

Interventions

Intensive Care Coordination OTHER

Intensive care coordination will include: * Discharge instructions and contacts for following up on care and treatment * Referral information * Appointment scheduling * Medication instructions * Intensive care coordination by a social worker, case manager, nurse, or care coordinator to connect Medical Assistance (MA) recipient to a primary care provider or to a managed care organization * Information about other health and social resources, such as transportation and housing * Sharing of information (discharge instructions, medication information, and care plan information) with managed care organization in which patients are enrolled, if applicable

Intensive Care Coordination

Eligibility Criteria

• Age: 18 Years - 64 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Inclusion Criteria: * Adults who are Medicaid enrolled * Have had 5+ emergency department visits in the past year Exclusion Criteria: * Participants who are concurrently eligible for Medicare * Children (individuals age \<18 years).

You may qualify if:

• Adults who are Medicaid enrolled
• Have had 5+ emergency department visits in the past year

You may not qualify if:

• Participants who are concurrently eligible for Medicare
• Children (individuals age \<18 years).

Sponsors & Collaborators

• University of Wisconsin, Madison: lead

Study Sites (4)

ThedaCare

Appleton, Wisconsin, 54911, United States

Location

Ascension Wisconsin

Glendale, Wisconsin, 53217, United States

Location

Aurora Health Care

Milwaukee, Wisconsin, 53202, United States

Location

Froedtert Health , Wisconsin

Wauwatosa, Wisconsin, 53226, United States

Location

Study Officials

• Rebecca Myerson, MPH, PhD

  University of Wisconsin, Madison

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 9, 2020
• First Posted: September 16, 2020
• Study Start: March 1, 2022
• Primary Completion: December 15, 2024
• Study Completion: December 15, 2024
• Last Updated: January 10, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (4)