Wisconsin Evaluation of Emergency Department Care Coordination

Overview

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. Investigators will conduct an evaluation to answer these questions. The evaluation will be structured as a randomized trial in order to effectively measure the impact of care coordination and referrals on ED visits among Medicaid patients in Wisconsin. The study will 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.

Full Title of Study: “Evaluation of an Intensive Care Coordination Program to Reduce Use of Hospital Emergency Department Services by Wisconsin Medicaid Members”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: None (Open Label)
  • Study Primary Completion Date: September 2023

Interventions

  • Other: Intensive Care Coordination
    • Intensive care coordination will include: Discharge instructions and contacts for following up on care and treatment Referral information Appointment scheduling Medication instructions Intensive care coordination by a social worker, case manager, nurse, or care coordinator to connect Medical Assistance (MA) recipient to a primary care provider or to a managed care organization Information about other health and social resources, such as transportation and housing Sharing of information (discharge instructions, medication information, and care plan information) with managed care organization in which patients are enrolled, if applicable

Arms, Groups and Cohorts

  • Experimental: Intensive Care Coordination
    • Intensive Care Coordination along with Standard of Care
  • No Intervention: Control
    • Standard of Care alone

Clinical Trial Outcome Measures

Primary Measures

  • Total Number of Emergency Department Visits
    • Time Frame: 6 months
  • Total Number of Emergency Department Visits
    • Time Frame: 12 months
  • Total Number of Emergency Department Visits
    • Time Frame: 18 months
  • Total Number of Emergency Department Visits
    • Time Frame: 24 months
  • Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 6 months
  • Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 12 months
  • Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 18 months
  • Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 24 months
  • Cost to Medicaid for all Emergency Department Visits
    • Time Frame: 6 months
  • Cost to Medicaid for all Emergency Department Visits
    • Time Frame: 12 months
  • Cost to Medicaid for all Emergency Department Visits
    • Time Frame: 18 months
  • Cost to Medicaid for all Emergency Department Visits
    • Time Frame: 24 months
  • Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 6 months
  • Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 12 months
  • Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 18 months
  • Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions
    • Time Frame: 24 months

Secondary Measures

  • Total Number of Primary Care Visits
    • Time Frame: 6, 12, 18, and 24 months
  • Number of Participants Who Used Any Primary Care Visits
    • Time Frame: 6, 12, 18, and 24 months
  • Number of Participants Who Used Specialty Care Visits
    • Time Frame: 6, 12, 18, and 24 months
  • Total Number of Specialty Care Visits
    • Time Frame: 6, 12, 18, and 24 months
  • Number of Participants with Any Hospitalizations
    • Time Frame: 6, 12, 18, and 24 months
  • Number of Hospitalization Events
    • Time Frame: 6, 12, 18, and 24 months
  • Number of visits to use behavioral health resources, if applicable for the participant
    • Time Frame: 6, 12, 18, and 24 months
  • Number of visits to use alcohol and other drug abuse resources if applicable for the participant
    • Time Frame: 6, 12, 18, and 24 months
  • Total Cost Related to the Use of Behavioral Health Resources if applicable for the participant
    • Time Frame: 6, 12, 18, and 24 months
  • Total Cost Related to Use of Alcohol and other Drug Abuse Resources if applicable for the participant
    • Time Frame: 6, 12, 18, and 24 months
  • Total costs of care to Medicaid
    • Time Frame: 6, 12, 18, and 24 months
  • Number of participants enrolled in Temporary Assistance for Needy Families (TANF)
    • Time Frame: 6, 12, 18, and 24 months
  • Number of participants enrolled in FoodShare
    • Time Frame: 6, 12, 18, and 24 months
    • FoodShare is a program that helps people with limited resources buy the food they need for good health.

Participating in This Clinical Trial

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).

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 64 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • University of Wisconsin, Madison
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Rebecca Myerson, MPH, PhD, Principal Investigator, University of Wisconsin, Madison
  • Overall Contact(s)
    • Donna Friedsam, 608-265-9377, dafriedsam@wisc.edu

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