Connecting Low-Income Adults to Primary Care After Inpatient Discharge

Study Overview
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Brief Summary
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Healthcare systems and insurers have tried to reduce costs by improving the care and coordination provided to patients with high healthcare spending. Often termed, hotspotting, these interventions seek to lower costs by reducing care provided in fragmented, high-cost settings, including the emergency department and inpatient settings, by addressing the social determinants of health and improving patients' access to lower-cost, ambulatory settings. Vanderbilt University Medical Center (VUMC), in collaboration with Tennessee's Medicaid agency (TennCare), is piloting a program to reduce costs and improve the quality of care provided to high-risk TennCare enrollees by referring them from inpatient settings to VUMC primary care services. This study seeks to evaluate this pilot by comparing outcomes between Medicaid patients referred to VUMC primary care services and similar Medicaid patients not referred to VUMC primary care services using data from surveys and administrative sources, including electronic health records and health insurance claims.

Official Title
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Connecting Low-Income Adults to Primary Care After Inpatient Discharge

Conditions
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Health Care Utilization, Health Care Seeking Behavior

Intervention / Treatment
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* Other: Access to primary care services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 or older Currently enrolled in Tennessee's Medicaid Program (TennCare) Presenting in VUMC's inpatient setting Reporting no active relationship with a primary care doctor Lives in Davidson County, Tennessee, or a surrounding county Exclusion Criteria: Patients discharged to a setting other than the community (e.g. to a Skilled Nursing Facility)

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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pilot Group<br>This group of TennCare recipients will be referred to VUMC primary care services and will be allowed to utilize these services for at least two years. Those referred to VUMC primary care services will be those who belong to the two of state's three Medicaid Managed Care plans who have agreed to participate in this pilot. | Other: Access to primary care services<br>* Those in the pilot group will be referred to primary care services and allowed to utilize them for at least two years. Primary care services include access to a primary care physician, medical management, and other tasks typically performed by a general practitioner. Those referred to primary care services will not have access to other VUMC outpatient services.<br>|
| Control Group<br>This group of TennCare recipients will not be referred to VUMC primary care services and will receive care as usual. Those not referred to VUMC primary care services will be those who belong to one of the state's three Medicaid Managed Care plans who has not agreed to participate in this pilot. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Inpatient Admissions | How many times the participant is hospitalized within the specified time period | 30, 60, 90, 180, and 360 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Emergency Department Visits | How many times the participant presents to the emergency department within the specified time period | 30, 60, 90, 180, and 360 days | 
| Number of Primary Care Visits | How many times the participant has seen a primary care physician within the specified time period | 30, 60, 90, 180, and 360 days | 
| Average Health Care Spending | Health care expenditures by the patient within the specified time frame | 30, 60, 90, 180, and 360 days | 
| Average Self-reported Health Status | A measure of the patient's self-reported physical and mental health, as measured by a shorter, modified version of the Short Form (SF)-36 | 30, 60, 90, 180, and 360 days | 
| Average of Disease Specific Outcomes | Depending on the clinical information that is captured, disease specific clinical outcomes (e.g. prevalence of hypertension; HbA1C levels) will also be reported | 30, 60, 90, 180, and 360 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Care Costs, Hospitalizations, Emergency Department Use, Health Care Accessibility, Medicaid, Low-income populations