Clinical trial NCT00385879: The Effects of Case Management in a Medicaid Managed Care Plan
Official title: The Effects of Case Management in a Medicaid Managed Care Plan
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Neoplasms
Heart Diseases
Adrenal Cortex Diseases
Lead sponsor: Metropolitan Jewish Health System
Sponsor class: OTHER
First posted: 2006-10-11
Enrollment: 500
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: SUPPORTIVE_CARE

Brief summary: The purpose of this study is to evaluate whether or not case management by a social worker and nurse can decrease the number of emergency room visits, increase the number of primary care doctor visits, and increase quality of life of people in a Medicaid managed care plan.

Detailed description: This study will assign participants based on Zip Code to one of two conditions: control and experimental. In the control group, participants will receive telephonic assessments at baseline, three months, and six months. These assessments will be conducted by a member of the Medical Center's Department of Geriatrics under the supervision of the Principal Investigator. Participants in the experimental group will receive medical case management provided by a nurse and social worker in the homecare setting including an in-home assessment. Assessments will be conducted at baseline, three months, and six months during routine homecare visits. Dependent variables being measured include: access to primary care physicians, emergent hospitalizations/admissions, articulation of advance directives, and quality of life. Data will be collected through the participants' medical claims and records to analyze the number of emergent hospitalizations/admissions, documentation of advance directives, and number of visits to primary care physicians. To measure participants' quality of life, the Depression Self-Rating Scale and the Clinical Anxiety Scale will be utilized. Data will be compared between and within the groups via statistical analyses. The researcher will conduct pre-post comparisons of utilization and other database-derived outcomes for both groups, comparing the 12 months prior to and up to 20 months following enrollment.

Eligibility criteria: Inclusion Criteria:

* participation in a Medicaid managed care plan
* resident of identified zip codes in Brooklyn, NY
* frequent hospitalizations and low frequency of primary doctor visits

Exclusion Criteria:

* residents outside the catchment area
* patients not being managed in a Medicaid managed care plan

Primary outcomes:
measure: The outcome measure for the number of emergency room visits will be calculated from the medical record counting the number of hospital emergency room visits; for access to primary physicians, the medical record will be reviewed as well.
Secondary outcomes:
measure: The outcomes for quality of life will be evaluated from the McGill Quality of Life Questionnaire.
Other outcomes:
Locations:
city: Brooklyn
country: United States
facility: Metropolitan Jewish Health System
state: New York
Study officials:
affiliation: Maimonides Medical Center
name: Barbara Paris, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Chattopadhyay A, Bindman AB. The contribution of Medicaid managed care to the increasing undercount of Medicaid beneficiaries in the Current Population Survey. Med Care. 2006 Sep;44(9):822-6. doi: 10.1097/01.mlr.0000218835.78953.53.