A Comprehensive Disease Management Program for Medically-Complex Substance Users

NCT ID: NCT00865956

Last Updated: 2018-10-10

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-03-31
• Study Completion Date: 2010-06-30

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.

Conditions

Substance-related Disorder

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: NONE

Study Groups

Care Management

Care Management plus voucher incentives for adherence to primary care appointments.

Group Type: EXPERIMENTAL

Contingency Management

Intervention Type: BEHAVIORAL

Rite Aid vouchers (stepped value) for reinforcement of adherence to primary care

Case management

Intervention Type: OTHER

Nurse case manager assigned to participant

Usual care

Usual care

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Contingency Management

Rite Aid vouchers (stepped value) for reinforcement of adherence to primary care

Intervention Type: BEHAVIORAL

Case management

Nurse case manager assigned to participant

Intervention Type: OTHER

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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Johns Hopkins Community Physicians

OTHER

Sponsor Role: collaborator

Johns Hopkins University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

J Hunter Young, MD, MHS

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins University

Locations

East Baltimore Medical Center

Baltimore, Maryland, United States

Countries

United States

Other Identifiers

NA_00015261

Identifier Type: -

Identifier Source: org_study_id