Clinical trial NCT00865956: A Comprehensive Disease Management Program for Medically-Complex Substance Users
Official title: A Comprehensive Disease Management Program for Medically-Complex Substance Users
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: NA
Conditions: Substance-related Disorder
Keywords: disease management
substance use disorders
behavioral incentives
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
Collaborators: name: Johns Hopkins Community Physicians
First posted: 2009-03-20
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Disease management (DM) programs are being increasingly utilized by health plans to coordinate care, improve quality of care, and control costs in chronically ill individuals. DM programs for specific medical conditions, such as diabetes mellitus, congestive heart failure, and asthma, have demonstrated improvements in health outcomes and a number of studies have found economic benefits to these programs as well. There are fewer data evaluating multi-disease DM programs, and results have been mixed. Additionally, data on such programs specifically targeting substance-using populations are limited, although they are promising. Prior utilization and hospitalization data from Johns Hopkins Hospital, Johns Hopkins Health Care, and Priority Partners Managed Care Organization (PPMCO) suggest that a substantial portion of high-utilizing, high-cost, medically complex patients have a substance use diagnosis.

The investigators hypothesize that a comprehensive DM program for medically-complex substance users with a history of hospitalization, consisting of intensive nurse case management along with behavioral incentives to reinforce engagement in primary care, can decrease inpatient days and costs, as well as improve outcomes for substance use, depression, and physical and mental functioning. The investigators will compare the case management/behavioral incentives intervention to usual care among a group of medically-complex, substance-using, PPMCO enrollees. Usual care will include access to all existing Priority Partners care management programs, and usual The investigators believe that this research will make an important contribution to the development of models of chronic care that improve health and promote the best use of health care resources. Additionally, the investigators believe this project will promote the study and development of systems to improve the health of substance-using adults, an underserved and often marginalized group.


Eligibility criteria: Inclusion Criteria:

* Age over 18
* Continuous enrollment in Priority Partners MCO for past 12 months
* Primary care site East Baltimore Medical Center (EBMC)
* PPMCO substance abuse flag other than nicotine only within past 24 months

Exclusion Criteria:

* currently enrolled in PPMCO Care Management

Primary outcomes:
measure: Per member per month expenditures
timeFrame: 12 months
Secondary outcomes:
measure: Hospitalization days
timeFrame: 12 months
measure: Outpatient visits
timeFrame: 12 months
measure: Emergency Department visits
timeFrame: 12 months
measure: Substance use disorder treatment
timeFrame: 12 months
measure: Self-reported substance use
timeFrame: 12 months
measure: Physical and mental functioning
timeFrame: 12 months
measure: Depression
timeFrame: 12 months
Other outcomes:
Locations:
city: Baltimore
country: United States
facility: East Baltimore Medical Center
state: Maryland
Study officials:
affiliation: Johns Hopkins University
name: J Hunter Young, MD, MHS
role: PRINCIPAL_INVESTIGATOR
References: