Clinical trial NCT04550169: Wisconsin Evaluation of Emergency Department Care Coordination
Official title: Evaluation of an Intensive Care Coordination Program to Reduce Use of Hospital Emergency Department Services by Wisconsin Medicaid Members
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Emergency Department Visit
Keywords: Medicaid
CARES (Wisconsin Client Assistance for Re-Employment and Economic Support)
Lead sponsor: University of Wisconsin, Madison
Sponsor class: OTHER
First posted: 2020-09-16
Enrollment: 3405
Sex: ALL
Minimum age (years): 18
Maximum age (years): 64
Standard ages: ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Inclusion Criteria:

* Adults who are Medicaid enrolled
* Have had 5+ emergency department visits in the past year

Exclusion Criteria:

* Participants who are concurrently eligible for Medicare
* Children (individuals age \<18 years).

Brief summary: The State of Wisconsin is now expanding its investment in care coordination models as an effort to reduce inappropriate hospital emergency department (ED) use, improve health outcomes, and reduce Medicaid expenditures. This effort begins with a pilot program to support emergency department care coordination in hospitals and health systems that apply and are selected to participate in the pilot program.

The Wisconsin Medicaid program seeks to understand whether this program achieves its intended goals and, specifically, whether the Medicaid payment for such care coordination services produces the intended program outcomes. Hospitals will select members that will receive care coordination services. In a quasi-experimental approach, the study team will compare members that do vs. do not receive the services will be used examine the effects of care coordination and referrals on total ED visits, primary-care treatable ED visits, non-emergent ED visits, and health care costs, as well as the specific effects of referring patients to providers who offer low-cost and after-hours care. To assess the importance of targeting, study team will conduct stratified analyses of vulnerable groups such as people with disabilities and individuals with specific clinical needs.


Eligibility criteria: Inclusion Criteria:

* Adults who are Medicaid enrolled
* Have had 5+ emergency department visits in the past year

Exclusion Criteria:

* Participants who are concurrently eligible for Medicare
* Children (individuals age \<18 years).

Primary outcomes:
measure: Total Number of Emergency Department Visits
timeFrame: 6 months
measure: Total Number of Emergency Department Visits
timeFrame: 12 months
measure: Total Number of Emergency Department Visits
timeFrame: 18 months
measure: Total Number of Emergency Department Visits
timeFrame: 24 months
measure: Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 6 months
measure: Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 12 months
measure: Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 18 months
measure: Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 24 months
measure: Cost to Medicaid for all Emergency Department Visits
timeFrame: 6 months
measure: Cost to Medicaid for all Emergency Department Visits
timeFrame: 12 months
measure: Cost to Medicaid for all Emergency Department Visits
timeFrame: 18 months
measure: Cost to Medicaid for all Emergency Department Visits
timeFrame: 24 months
measure: Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 6 months
measure: Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 12 months
measure: Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 18 months
measure: Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
timeFrame: 24 months
Secondary outcomes:
measure: Total Number of Primary Care Visits
timeFrame: 6, 12, 18, and 24 months
measure: Number of Participants Who Used Any Primary Care Visits
timeFrame: 6, 12, 18, and 24 months
measure: Number of Participants Who Used Specialty Care Visits
timeFrame: 6, 12, 18, and 24 months
measure: Total Number of Specialty Care Visits
timeFrame: 6, 12, 18, and 24 months
measure: Number of Participants with Any Hospitalizations
timeFrame: 6, 12, 18, and 24 months
measure: Number of Hospitalization Events
timeFrame: 6, 12, 18, and 24 months
measure: Number of visits to use behavioral health resources, if applicable for the participant
timeFrame: 6, 12, 18, and 24 months
measure: Number of visits to use alcohol and other drug abuse resources if applicable for the participant
timeFrame: 6, 12, 18, and 24 months
measure: Total Cost Related to the Use of Behavioral Health Resources if applicable for the participant
timeFrame: 6, 12, 18, and 24 months
measure: Total Cost Related to Use of Alcohol and other Drug Abuse Resources if applicable for the participant
timeFrame: 6, 12, 18, and 24 months
measure: Total costs of care to Medicaid
timeFrame: 6, 12, 18, and 24 months
measure: Number of participants enrolled in Temporary Assistance for Needy Families (TANF)
timeFrame: 6, 12, 18, and 24 months
measure: Number of participants enrolled in FoodShare
timeFrame: 6, 12, 18, and 24 months
Other outcomes:
Locations:
city: Appleton
country: United States
facility: ThedaCare
state: Wisconsin
city: Glendale
country: United States
facility: Ascension Wisconsin
state: Wisconsin
city: Milwaukee
country: United States
facility: Aurora Health Care
state: Wisconsin
city: Wauwatosa
country: United States
facility: Froedtert Health , Wisconsin
state: Wisconsin
Study officials:
affiliation: University of Wisconsin, Madison
name: Rebecca Myerson, MPH, PhD
role: PRINCIPAL_INVESTIGATOR
References: