Health Coach Program to Improve Chronic Disease Outcomes Following an Emergency Department Visit

Study Overview
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Brief Summary
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The purpose of this study is to determine whether health coaching initiated in the emergency department (ED) reduces subsequent ED visits, increases primary care visits, and positively impacts health outcomes in patients with diabetes and/or hypertension.

Detailed Description
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Patients will be recruited by health coaches from the Highland Hospital Emergency Department. Eligible patients who agree to participate will be randomized to the control and experimental groups in a 2:1 ratio respectively because experimental group size is limited by health coach availability and greater loss-to-follow up is expected among the control group. Repeated measures analysis will be used to compare each outcome over the study period. In addition, subgroup analyses will be performed in order to stratify by baseline survey measures or amount of ED visits in the pre-observation period.

Conditions
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Hypertension, Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Health Coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing to work with a health coach Plans to reside in Alameda County for the next year Has a reliable phone number Speaks English or Spanish 18 years of age or older Meets at least one of the following three criteria: (1) Low medication adherence defined as a continuous medication gap of at least 1 month in the past year OR a new diagnosis of diabetes and/or hypertension; (2) No patient-identified primary care provider (PCP) or no visit to PCP in 1 year; (3) One or more visits to the ED in the last 6 months. Exclusion Criteria: Life-expectancy less than 1 year Poorly controlled psychiatric illness Homeless Active and frequent use of illicit substances Currently incarcerated Already enrolled in a program for patients with high rates of hospitalization and/or emergency department visits Unable to consent due to an unstable condition or serious emotional or neurologic condition Admitted or anticipated to be admitted to the hospital from the ED

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Health Coaching<br>Patients randomized to the experimental arm receive six months of post-ED health coaching from the Alameda County Health Coach Program (ACHCP) in addition to usual care in the emergency department at enrollment. | Behavioral: Health Coaching<br>* The Alameda County Health Coach program pairs patients with a language-concordant health coach for six months following an ED visit. Health coaches are young adults from the local community employed through Alameda County and trained for three months in topics such as self-management support and motivational interviewing. Health coaches work one-on-one with participants in order to develop an action plan in order to achieve patient-identified health goals. Communication between the health coach and participant includes text messages (weekly), phone calls (twice a month), face-to-face visits (at least once), and accompaniment to a primary care visit (at least once). Health coaches may also assist participants in accessing community resources as related to the individualized action plan.<br>|
| No Intervention: Usual Care<br>Patients randomized to the control arm receive usual care in the emergency department at enrollment. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of emergency department visits | Self-reported measure collected via follow-up phone surveys at 1, 3, and 6 months. | 6 month period after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of primary care visits | Self-reported measure collected by follow-up phone surveys at 1,3, and 6 months. | 6 month period after enrollment | 
| Physical health and mental health (Validated measure - SF-12v2) | Validated measure (SF-12v2) collected at baseline and follow-up phone surveys. | Baseline, 1 month, 3 months, and 6 months after enrollment | 
| Medication adherence (Validated measure - Morisky Medication Adherence Scale, MMAS-8) | Validated measure (Morisky Medication Adherence Scale, MMAS-8) collected at baseline and follow-up phone surveys. | Baseline, 1 month, 3 months, and 6 months after enrollment | 
| Patient activation (Validated measure - Patient Activation Measure, PAM) | Validated measure (Patient Activation Measure, PAM) collected at baseline and follow-up phone surveys. | Baseline, 1 month, 3 months, and 6 months after enrollment | 
| Type and frequency of health coach contact | Health coach documentation notes will be analyzed to determine the average percent of each type of contact (text, phone, or in-person) and frequency of contact. | 6 months after enrollment | 
| Percent of action plan goals achieved (Health coach documentation notes) | Health coach documentation notes will be analyzed to determine the percent of goals achieved during the intervention. | 6 months after enrollment | 
| Qualitative analysis of action plans (Health coach documentation notes will be analyzed, data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan) | Health coach documentation notes will be analyzed using a grounded theory approach, where transcribed data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan. | 6 months after enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Service, Community Health Workers, Community Health Workers: utilization, Primary Health Care/utilization, Health Services Accessibility