Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial

Author:

Brooks Carthon J MargoORCID,Brom HeatherORCID,Grantham-Murrillo MarshaORCID,Sliwinski KathyORCID,Mason AleighaORCID,Roeser MindiORCID,Miles DonnaORCID,Garcia DianneORCID,Bennett JovanORCID,Harhay Michael OORCID,Flores EmiliaORCID,Amenyedor KelvinORCID,Clark RebeccaORCID

Abstract

Background Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE—an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. Objective The study’s objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. Methods We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. Results This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. Conclusions The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/54211 Trial Registration ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605

Publisher

JMIR Publications Inc.

Reference55 articles.

1. Eliminating Health Disparities Will Require Looking at How Much and How Medicaid Pays Participating Providers

2. KronickRBellaMGilmerTPThe faces of Medicaid III: refining the portrait of people with multiple chronic conditionsCenter for Health Care Strategies, Inc20092024-02-07https://www.chcs.org/media/Executive_Summary_-_Faces_III1.pdf

3. BarrettMLWierLMJiangHJSteinerCAAll-cause readmissions by payer and age, 2009-2013Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP): Statistical Briefs #19920152024-02-14https://hcup-us.ahrq.gov/reports/statbriefs/sb199-Readmissions-Payer-Age.jsp

4. GilmerTHamblinAHospital readmissions among Medicaid beneficiaries with disabilities: identifying targets of opportunityCenter for Health Care Strategies, Inc20102024-02-07https://www.chcs.org/media/CHCS_readmission_101215b.pdf

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3