Case Management for Health Care Superutilizers
What You Need to Know Before You Apply
What is the purpose of this trial?
This trial tests a special care program designed to help people who frequently end up in the hospital by better coordinating their healthcare. The goal is to determine if expanding this program to more insured members at high risk can reduce hospital visits. Participants may receive different combinations of care management, including nurse-led coordination (RN case management) and community health support (Community Health Worker Case Management). This trial suits insured individuals identified as high-risk for frequent hospital care. As an unphased trial, it offers a unique opportunity for patients to contribute to innovative healthcare solutions that could enhance care coordination and reduce hospital visits.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.
Is there any evidence suggesting that this trial's treatments are likely to be safe?
Research has shown that case management and care coordination are generally safe for patients. These methods connect all of a patient's healthcare providers, ensuring effective communication and avoiding repeated treatments, which enhances safety.
For RN Standard care coordination and disease management combined with RN Case Management, safety remains a top priority. The focus lies in improving patient safety by planning care carefully and aiming for the best outcomes.
Similarly, RN Standard care coordination and disease management combined with Community Health Worker Case Management is also considered safe. This approach effectively organizes patient care activities.
Overall, these treatments are well-tolerated, with no significant negative effects reported in studies. They offer a safe option for managing complex health needs.12345Why are researchers excited about this trial?
Researchers are excited about these treatments because they're exploring new ways to manage care for health care superutilizers, who frequently use medical services. Unlike standard care coordination, these approaches integrate case management by Registered Nurses (RNs) and Community Health Workers, offering a more personalized and comprehensive support system. By combining professional expertise with community-based insights, these methods aim to improve patient outcomes and reduce the strain on healthcare resources. This innovative approach could lead to more efficient care and better health for patients who need it most.
What evidence suggests that this trial's treatments could be effective for reducing acute inpatient admissions?
This trial will compare different case management approaches for health care superutilizers. Research has shown that combining regular care from registered nurses (RNs) with support from community health workers effectively manages complex health needs. In this trial, one arm will receive RN Standard care coordination and disease management combined with RN Case Management, while another arm will receive RN Standard care coordination and disease management combined with Community Health Worker Case Management.
Case management provides focused care for individuals with complicated health and social needs, improving care by making it more organized and continuous. Studies have also shown that community health workers play a crucial role in reducing health problems by offering health and disease management services.
For RN case management, evidence suggests that nurse-led care helps reduce health disparities and improve overall well-being, especially for patients with complex conditions. Reports from programs focusing on patients with high health care needs have found that intensive outpatient care management is particularly effective for these groups. These methods aim to improve health outcomes and may reduce hospital visits by providing more coordinated and continuous care.16789Who Is on the Research Team?
Anthony V Pirrello, MS
Principal Investigator
UnitedHealthcare
Are You a Good Fit for This Trial?
This trial is for UnitedHealthcare commercial members over 18 years old, in any state, who are at high risk of frequent hospital visits as determined by a special algorithm. It's not for pregnant women, those with 'do not contact' status, on infertility treatment or part of certain health plans like ACOs or legacy UHC groups.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive standard care coordination and disease management, with some receiving additional case management
Follow-up
Participants are monitored for safety and effectiveness after treatment
Long-term Monitoring
Participants are monitored for various health outcomes such as emergency room visits, diabetes-related complications, and adherence to care processes
What Are the Treatments Tested in This Trial?
Interventions
- Community Health Worker Case Management
- RN case management
- RN Standard care coordination and disease management
Trial Overview
The study tests if expanding Standard Care Coordination (SCC), which includes case management and care coordination by RNs and community health workers, to high-risk insured members can reduce hospital admissions. Participants are randomly chosen to receive SCC.
How Is the Trial Designed?
3
Treatment groups
Experimental Treatment
RN Standard care coordination and disease management + Community Health Worker Case Management
RN Standard care coordination and disease management + RN Case Management
RN Standard care coordination and disease management
Community Health Worker Case Management is already approved in United States for the following indications:
- High-risk patient management
- Complex care coordination
- Prevention of acute inpatient admissions
Find a Clinic Near You
Who Is Running the Clinical Trial?
UnitedHealthcare
Lead Sponsor
University of California, Los Angeles
Collaborator
Published Research Related to This Trial
Citations
Nursing Care Coordination for Patients with Complex Needs ...
Case management is perhaps the most intensive intervention for caring for people with complex health and social needs [19]. Case management has ...
Care Coordination Models and Tools—Systematic Review ...
Care coordination (CC) interventions involve systematic strategies to address fragmentation and enhance continuity of care.
Super-Utilizer Summit Common Themes from
Super-utilizer programs provide intensive outpatient care management to patient subpopulations with very complex physical, behavioral, and social needs. Because ...
BUILDING A COMMUNITY HEALTH WORKER PROGRAM
In coordination with mainstream health care providers, CHWs offer health, wellness, and disease prevention and management services in order to decrease ...
(PDF) Care Coordination: A Concept Analysis
We aim to further clarify care coordination as a concept and practice role and examine the value that nursing brings to its implementation.
Case Management - StatPearls - NCBI Bookshelf - NIH
Case management is defined as a health care process in which a professional helps a patient or client develop a plan that coordinates and integrates the ...
Care Coordination Case Study: Preliminary Findings
Care coordination entails linking all of a patient's service providers, ensuring effective communication, monitoring service delivery, preventing duplication of ...
Care Coordination versus Case Management: What's the ...
Care coordination is broader, emphasizing continuous, integrated care, whereas case management is more focused and structured around specific health issues.
Care Coordination
Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's ...
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