Clinical trial NCT05176977: Homeless Veterans and Peer Whole Health Coaching
Official title: Using Data Analytics and Targeted Whole Health Coaching to Reduce Frequent Utilization of Acute Care Among Homeless Veterans
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Acute Care Service Utilization
Mental Health Status
Physical Health Status
Housing
Keywords: Homeless Persons
Costs and Cost Analysis
Mental Health
Peer Support
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2022-01-04
Enrollment: 177
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Use of acute care services (e.g., hospitalizations, Emergency Department visits) contributes substantially to the cost of healthcare for Veterans. Homelessness is a robust social determinant of super utilization of acute care. The goal of this project is to test if Peer Specialists trained in Whole Health Coaching can reduce homeless Veterans' frequent use of acute care.

Detailed description: Ten percent of patients account for up to 70% of acute care costs. Among these "super-utilizer" patients, homelessness is a robust social determinant of acute care utilization. Through a field-based dashboard and clinical aids, the Hot Spotter Analytic program assists Patient Aligned Care Teams (PACT) with targeting and tailoring care for the highest-need homeless Veterans. However, many Veterans identified by the Analytics do not engage in supportive services that reduce risk for acute care utilization. Peer Specialists (PS) are a high-value workforce that can facilitate Veterans' engagement in care. Yet, there is a need to enhance the PS role with a structured approach that can capitalize on known facilitators of care engagement among homeless Veterans. Whole Health Coaching (WHC) is one such approach. By focusing on patients' values and goals rather than treatment of specific conditions, WHC reduces patients' stigma regarding their care needs and increases patient activation and well-being, which can increase engagement in supportive services.

The goal of this project is to integrate use of Hot Spotter Analytics with Peer Specialists trained in Whole Health Coaching (PS-WHC) and evaluate whether this approach reduces homeless Veterans' frequent use of acute care. Using a Hybrid Type 1 design at the Palo Alto, Bedford, and North Little Rock VAs, the investigators will test whether receipt of PS-WHC (vs. Enhanced Usual Care; EUC) predicts (1a) lower acute care utilization, (1b) better health-related outcomes, and whether (1c) the effects of PS-WHC on 1a and 1b are mediated by increased (i) patient activation and well-being, and (ii) access to supportive services. Aim 2: Conduct a process evaluation to inform VA's potential widespread implementation of Hot Spotter Analytics + PS-WHC on PACTs. Aim 3: Conduct a Budget Impact Analysis to determine the impact on total costs of VA care due to implementing PS-WHC.

Eligibility criteria: Inclusion Criteria:

Veterans who:

* are on VA's Homeless Registry, which comprises those who utilized any VA homeless programs and services in the past 2 years
* are enrolled on a Patient Aligned Care Team (or "PACT") at a study site
* had a hot spotter qualifying event in two or more quarters in the past year will be eligible for participation

Exclusion Criteria:

* Veterans who have a suicidal and/or behavioral flag in their medical record and those who are too cognitively impaired to understand the informed consent process and other study procedures will be excluded

Primary outcomes:
measure: Days of all-cause hospitalization
timeFrame: 9 months (post-baseline)
Secondary outcomes:
measure: ED visits
timeFrame: 9 months (post-baseline)
measure: Substance Use
timeFrame: 9 months (post-baseline)
measure: Alcohol Use Problems (AUDIT)
timeFrame: 9 months (post-baseline)
measure: Depression (PHQ-9)
timeFrame: 9 months (post-baseline)
measure: PTSD (PCL-5)
timeFrame: 9 months (post-baseline)
measure: Days of Ambulatory Care Sensitive Condition (ACSC) hospitalizations
timeFrame: 9 months (post-baseline)
measure: Percent Days Homeless
timeFrame: 9 months (post-baseline)
measure: Days of mental health hospitalizations
timeFrame: 9 months (post-baseline)
measure: Patient Engagement (ACE)
timeFrame: 9 months (post-baseline)
measure: Days of medical hospitalizations
timeFrame: 9 months (post-baseline)
measure: Perceptions of Health (PROMIS-10)
timeFrame: 9 months (post-baseline)
measure: Peer service engagement
timeFrame: 9 months (post-baseline)
measure: Whole Health service engagement
timeFrame: 9 months (post-baseline)
Other outcomes:
Locations:
city: North Little Rock
country: United States
facility: Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
state: Arkansas
city: Palo Alto
country: United States
facility: VA Palo Alto Health Care System, Palo Alto, CA
state: California
city: Bedford
country: United States
facility: VA Bedford HealthCare System, Bedford, MA
state: Massachusetts
Study officials:
affiliation: VA Palo Alto Health Care System, Palo Alto, CA
name: Daniel M. Blonigen, PhD MA
role: PRINCIPAL_INVESTIGATOR
affiliation: VA Bedford HealthCare System, Bedford, MA
name: David A. Smelson, PsyD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Blonigen D, Hyde J, McInnes DK, Yoon J, Byrne T, Ngo T, Smelson D. Integrating data analytics, peer support, and whole health coaching to improve the health outcomes of homeless veterans: Study protocol for an effectiveness-implementation trial. Contemp Clin Trials. 2023 Feb;125:107065. doi: 10.1016/j.cct.2022.107065. Epub 2022 Dec 23.