Trial Outcomes & Findings for Impact of Medicaid Health Home on Patients With Diabetes in New York City (NCT NCT02713321)

NCT ID: NCT02713321

Last Updated: 2025-07-04

Results Overview

Proportion of hospitalizations related to diabetes that could have been prevented. Diabetes-related potentially preventable hospitalizations are admissions to a hospital for certain acute illnesses or worsening chronic conditions that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings.

Recruitment status

COMPLETED

Target enrollment

96759 participants

Primary outcome timeframe

Baseline and 12 months

Results posted on

2025-07-04

Participant Flow

Patients with clinical diabetes were identified from the INSIGHT Clinical Research Network electronic health record (EHR) data from 6 large academic NYC healthcare systems from 2010-2017.

Participant milestones

Participant milestones
Measure
Health Home Patients
The cohort is made up of patients with type 2 diabetes, insured by Medicaid, and eligible for participation in a Medicaid Health Home (either due to HIV infection, serious mental illness, or multiple chronic conditions). This group included patients who participated in the Health Home program.
Non-Health Home Patients
This group included patients who did participate in the Health Home program, but had type 2 diabetes, were insured by Medicaid, and met eligibility requirements for the Health Homes.
Before Matching/Weighting
STARTED
11969
84790
Before Matching/Weighting
COMPLETED
11646
73973
Before Matching/Weighting
NOT COMPLETED
323
10817
After Matching/Weighting ****
STARTED
11646
73973
After Matching/Weighting ****
COMPLETED
11646
26601
After Matching/Weighting ****
NOT COMPLETED
0
47372

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Impact of Medicaid Health Home on Patients With Diabetes in New York City

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Health Home Patients
n=11646 Participants
The cohort is made up of patients with type 2 diabetes, insured by Medicaid, and eligible for participation in a Medicaid Health Home (either due to HIV infection, serious mental illness, or multiple chronic conditions). This group included patients who participated in the Health Home program.
Non-Health Home Patients
n=26601 Participants
This group included patients who did participate in the Health Home program, but had type 2 diabetes, were insured by Medicaid, and met eligibility requirements for the Health Homes.
Total
n=38247 Participants
Total of all reporting groups
Age, Customized
15-44 years
1986 Participants
n=5 Participants
4535 Participants
n=7 Participants
6521 Participants
n=5 Participants
Age, Customized
45-64 years
7287 Participants
n=5 Participants
16644 Participants
n=7 Participants
23931 Participants
n=5 Participants
Age, Customized
65+ years
2383 Participants
n=5 Participants
5443 Participants
n=7 Participants
7826 Participants
n=5 Participants
Sex: Female, Male
Female
6999 Participants
n=5 Participants
15987 Participants
n=7 Participants
22986 Participants
n=5 Participants
Sex: Female, Male
Male
4647 Participants
n=5 Participants
10614 Participants
n=7 Participants
15261 Participants
n=5 Participants
Race/Ethnicity, Customized
Hispanic
5674 Participants
n=5 Participants
12960 Participants
n=7 Participants
18634 Participants
n=5 Participants
Race/Ethnicity, Customized
Non-Hispanic Black
3488 Participants
n=5 Participants
7967 Participants
n=7 Participants
11455 Participants
n=5 Participants
Race/Ethnicity, Customized
Non-Hispanic White
1228 Participants
n=5 Participants
2804 Participants
n=7 Participants
4032 Participants
n=5 Participants
Race/Ethnicity, Customized
Other/unknown
1266 Participants
n=5 Participants
2892 Participants
n=7 Participants
4158 Participants
n=5 Participants
Medicare
3841 Participants
n=5 Participants
8773 Participants
n=7 Participants
12614 Participants
n=5 Participants
SSI due to disability
5720 Participants
n=5 Participants
13066 Participants
n=7 Participants
18786 Participants
n=5 Participants
SSI due to age
2344 Participants
n=5 Participants
5355 Participants
n=7 Participants
7699 Participants
n=5 Participants
Serious mental illness diagnosis
6254 Participants
n=5 Participants
14285 Participants
n=7 Participants
20539 Participants
n=5 Participants
Alcohol or substance use disorder diagnosis
3136 Participants
n=5 Participants
7164 Participants
n=7 Participants
10300 Participants
n=5 Participants
Cancer diagnosis
1831 Participants
n=5 Participants
4182 Participants
n=7 Participants
6013 Participants
n=5 Participants
HIV diagnosis
3699 Participants
n=5 Participants
8448 Participants
n=7 Participants
12147 Participants
n=5 Participants
Number of chronic condition indicator (CCI)
17.0 indicators
STANDARD_DEVIATION 9.4 • n=5 Participants
17.0 indicators
STANDARD_DEVIATION 9.4 • n=7 Participants
17.0 indicators
STANDARD_DEVIATION 9.4 • n=5 Participants
Hospitalizations
1.0 hospitalizations
STANDARD_DEVIATION 2.1 • n=5 Participants
1.0 hospitalizations
STANDARD_DEVIATION 2.1 • n=7 Participants
1.0 hospitalizations
STANDARD_DEVIATION 2.1 • n=5 Participants
ED visits
1.1 visits
STANDARD_DEVIATION 4.0 • n=5 Participants
1.1 visits
STANDARD_DEVIATION 4.0 • n=7 Participants
1.1 visits
STANDARD_DEVIATION 4.0 • n=5 Participants

PRIMARY outcome

Timeframe: Baseline and 12 months

Population: Results for HH enrollees and a matched comparison group of HH non-enrollees

Proportion of hospitalizations related to diabetes that could have been prevented. Diabetes-related potentially preventable hospitalizations are admissions to a hospital for certain acute illnesses or worsening chronic conditions that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings.

Outcome measures

Outcome measures
Measure
Health Home Patients
n=11646 Participants
The cohort is made up of patients with type 2 diabetes, insured by Medicaid, and eligible for participation in a Medicaid Health Home (either due to HIV infection, serious mental illness, or multiple chronic conditions). This group included patients who participated in the Health Home program.
Non-Health Home Patients
n=26601 Participants
This group included patients who did participate in the Health Home program, but had type 2 diabetes, were insured by Medicaid, and met eligibility requirements for the Health Homes..
Number of Enrollees With Diabetes-related Preventable Hospitalizations
Baseline
48 Participants
109 Participants
Number of Enrollees With Diabetes-related Preventable Hospitalizations
12 months
48 Participants
90 Participants

SECONDARY outcome

Timeframe: 12 months

Number of primary care visits to assess the impact of Health Home (HH) enrollment compared to usual care among Medicaid-insured patients with diabetes and other chronic conditions on access to health care and social services and COVID-19 and non-COVID-19 clinical outcomes.

Outcome measures

Outcome measures
Measure
Health Home Patients
n=11646 Participants
The cohort is made up of patients with type 2 diabetes, insured by Medicaid, and eligible for participation in a Medicaid Health Home (either due to HIV infection, serious mental illness, or multiple chronic conditions). This group included patients who participated in the Health Home program.
Non-Health Home Patients
n=26601 Participants
This group included patients who did participate in the Health Home program, but had type 2 diabetes, were insured by Medicaid, and met eligibility requirements for the Health Homes..
Number of Primary Care Visits
10.9 visits
Standard Deviation 10.9
8.7 visits
Standard Deviation 10.9

SECONDARY outcome

Timeframe: 12 months

Number of months of Medicaid coverage to assess the impact of Health Home (HH) enrollment compared to usual care among Medicaid-insured patients with diabetes and other chronic conditions on access to health care and social services and COVID-19 and non-COVID-19 clinical outcomes.

Outcome measures

Outcome measures
Measure
Health Home Patients
n=11646 Participants
The cohort is made up of patients with type 2 diabetes, insured by Medicaid, and eligible for participation in a Medicaid Health Home (either due to HIV infection, serious mental illness, or multiple chronic conditions). This group included patients who participated in the Health Home program.
Non-Health Home Patients
n=26601 Participants
This group included patients who did participate in the Health Home program, but had type 2 diabetes, were insured by Medicaid, and met eligibility requirements for the Health Homes..
Number of Months of Medicaid Coverage
11.7 months
Standard Deviation 1.3
10.7 months
Standard Deviation 1.3

Adverse Events

Health Home Patients

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Non-Health Home Patients

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Victoria Mayer

Icahn School of Medicine at Mount Sinai

Phone: (212) 659-9194

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place