Clinical trial NCT04057521: Coordinated HEalthcare for Complex Kids
Official title: Coordinated HEalthcare for Complex Kids Impact on Medicaid Expenditures
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Asthma
Diabetes Mellitus
Sickle Cell Disease
Premature Birth
Keywords: care coordination
Children
Young adults
Chronic disease
Lead sponsor: University of Illinois at Chicago
Sponsor class: OTHER
Collaborators: name: Centers for Medicare and Medicaid Services
First posted: 2019-08-15
Enrollment: 6259
Sex: ALL
Maximum age (years): 26
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: For the purpose of program evaluation; 6,259 participants who met eligibility criteria for CHECK were randomized. These participants had no previous exposure to CHECK and were randomized to either enrollment into the CHECK program or to usual care (comparison group). Purposive randomization to CHECK or usual care by age, disease and risk level was conducted by Mathmatica.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The University of Illinois Health and Health Sciences System (UI Health) developed an integrated care management quality improvement model designed to provide comprehensive care coordination for Medicaid insured minority children and young adults with chronic health conditions living in Chicago. This program, called CHECK (Coordinated HEalthcare for Complex Kids), targeted children and young adults with chronic disease.

Detailed description: The University of Illinois Health and Health Sciences System (UI Health) developed an integrated care management quality improvement model designed to provide comprehensive care coordination for Medicaid insured minority children and young adults with chronic health conditions living in Chicago. This program, called CHECK (Coordinated HEalthcare for Complex Kids), was funded by a Centers for Medicare and Medicaid Services Innovation (CMMI) Award. The CHECK model took a broad approach to health promotion by addressing social determinants of health, caregiver wellness and mental health needs; in addition to disease management. The program targeted children and young adults from birth to age 25 with diagnoses of asthma, diabetes, sickle cell disease, seizure disorder or prematurity. All participants were enrolled in either the traditional (fee-for-service) state Medicaid program or a Medicaid Managed Care Organization (MCO) in Illinois. CHECK provided access to care coordination delivered by community health workers; mental health services and health education.

CHECK was designed as a demonstration program and participants were enrolled passively over time and received different services depending on their level of risk and need. One primary aim of the CHECK program was to decrease Medicaid expenditures over a three-year period by decreasing unnecessary emergency department visits and hospitalizations.

Though CHECK was designed as a care delivery demonstration program, in April, 2016 we had the opportunity to prospectively randomize 6,259 participants who met eligibility criteria for CHECK, for the purpose of program evaluation.

Eligibility criteria: Inclusion Criteria:

* Age 0-25 years;
* Documentation of asthma,
* Diabetes mellitus (type 1 or 2), sickle cell disease,
* Seizure disorder or
* Prematurity; 3)
* Enrolled in Medicaid; and
* Ride in Cook County, Illinois.

Exclusion criteria:

• None

Primary outcomes:
measure: Annual inpatient healthcare utilization per 1000 patient years
timeFrame: Three years
measure: Annual emergency room healthcare utilization per 1000 patient years
timeFrame: Three years
measure: Annual outpatient visit healthcare utilization per patient per 1000 patient years
timeFrame: Three years
Secondary outcomes:
measure: Annual inpatient healthcare expenditures per patient
timeFrame: Three years
measure: Annual emergency room healthcare expenditures per patient
timeFrame: Three years
measure: Annual outpatient healthcare expenditures per patient
timeFrame: Three years
measure: Annual prescription healthcare expenditures per patient
timeFrame: Three years
measure: Annual "other" healthcare expenditures per patient
timeFrame: Three years
measure: Annual total healthcare expenditures per patient
timeFrame: Three years
Other outcomes:
Locations:
Study officials:
affiliation: University of Illinois at Chicago
name: Benjamin VanVoorhees, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Glassgow AE, Martin MA, Caskey R, Bansa M, Gerges M, Johnson M, Marko M, Perry-Bell K, Risser HJ, Smith PJ, Van Voorhees B. An innovative health-care delivery model for children with medical complexity. J Child Health Care. 2017 Sep;21(3):263-272. doi: 10.1177/1367493517712063. Epub 2017 Jun 5.
citation: Bansa M, Glassgow AE, Martin M, Caskey R, Paulson A, Minier M, Roper P, Mitacek R, Wilder J, Van Voorhees B. Development of a Community-Based Medical Neighborhood for Children with Chronic Conditions. Prog Community Health Partnersh. 2019;13(1):83-95. doi: 10.1353/cpr.2019.0011.
citation: Caskey R, Moran K, Touchette D, Martin M, Munoz G, Kanabar P, Van Voorhees B. Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial. JAMA Netw Open. 2019 Oct 2;2(10):e1912604. doi: 10.1001/jamanetworkopen.2019.12604.