Patient Navigation for Medicaid Frequent ED Users

Study Overview
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Brief Summary
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A large proportion of frequent ED users have Medicaid insurance. The purpose of this study is to evaluate the effectiveness of patient navigation for reducing Emergency Department (ED) visits and hospitalizations and improving patient-centered outcomes (e.g., self-reported health status, quality of life, access/barriers to care) among Medicaid patients who are high utilizers of the ED, as well as to identify best practices for engaging and providing healthcare services to underserved patients using patient navigation. This study will address needs that have been identified within the New Haven community and the local healthcare system, contribute to knowledge and literature surrounding the use of patient navigation to improve care for underserved patients and improve health system efficiency, and inform the design and development of programs that address these needs both locally and in other communities.

Official Title
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Patient Navigation to Improve Care and Reduce Costs for High Utilizers of the Emergency Department

Conditions
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Chronic Illness

Intervention / Treatment
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* Behavioral: Patient Navigator
* Other: Standard of Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 4-18 ED visits per year Frequent ED users age 18 to 62 Medicaid insurance only Those living in the greater New Haven area (i.e. having a zip code that matches that) Exclusion Criteria: the current visit for primary psychiatric or substance abuse more than 50% of all ED visits in the past year for primary psychiatric or substance abuse.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 62 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient Navigator<br>Patients in the experimental group will be offered patient navigation and timely access to comprehensive care and services through Project Access-New Haven (PA-NH). | Behavioral: Patient Navigator<br>* Patients in the intervention group will be offered patient navigation and timely access to comprehensive care and services through Project Access-New Haven (PA-NH), a local non-profit organization that coordinates the provision of donated medical care and services to underserved patients through a network of participating hospitals and volunteer physicians.<br>|
| Active Comparator: Standard of Care<br>Patients in the active comparator group will experience the usual intake process in the ED setting. | Other: Standard of Care<br>* Patients in the standard of care group will experience the usual intake process in the ED setting.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of ED visits | Additional outcomes include number of hospitalizations, number of outpatient visits, and outpatient imaging utilization. | One Year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of hospitalizations |  | One Year | 
| Number of outpatient visits |  | One Year | 
| Costs by analyzing global use with Medicaid claims data |  | One year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PATIENT NAVIGATION, HEALTHCARE UTILIZATION, ED UTILIZATION, PRIMARY CARE UTILIZATION, UNDERSERVED POPULATIONS, HEALTH DISPARITIES