Health Care Seeking Behavior, Health Care Utilization
Conditions
Keywords
Health Care Costs, Hospitalizations, Emergency Department Use, Health Care Accessibility, Medicaid, Low-income populations
Brief summary
Healthcare systems and insurers have tried to reduce costs by improving the care and coordination provided to patients with high healthcare spending. Often termed, hotspotting, these interventions seek to lower costs by reducing care provided in fragmented, high-cost settings, including the emergency department and inpatient settings, by addressing the social determinants of health and improving patients' access to lower-cost, ambulatory settings. Vanderbilt University Medical Center (VUMC), in collaboration with Tennessee's Medicaid agency (TennCare), is piloting a program to reduce costs and improve the quality of care provided to high-risk TennCare enrollees by referring them from inpatient settings to VUMC primary care services. This study seeks to evaluate this pilot by comparing outcomes between Medicaid patients referred to VUMC primary care services and similar Medicaid patients not referred to VUMC primary care services using data from surveys and administrative sources, including electronic health records and health insurance claims.
Interventions
OTHERAccess to primary care services
Those in the pilot group will be referred to primary care services and allowed to utilize them for at least two years. Primary care services include access to a primary care physician, medical management, and other tasks typically performed by a general practitioner. Those referred to primary care services will not have access to other VUMC outpatient services.
Sponsors
Vanderbilt University Medical Center
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or older * Currently enrolled in Tennessee's Medicaid Program (TennCare) * Presenting in VUMC's inpatient setting * Reporting no active relationship with a primary care doctor * Lives in Davidson County, Tennessee, or a surrounding county
Exclusion criteria
* Patients discharged to a setting other than the community (e.g. to a Skilled Nursing Facility)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Inpatient Admissions | 30, 60, 90, 180, and 360 days | How many times the participant is hospitalized within the specified time period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Emergency Department Visits | 30, 60, 90, 180, and 360 days | How many times the participant presents to the emergency department within the specified time period |
| Number of Primary Care Visits | 30, 60, 90, 180, and 360 days | How many times the participant has seen a primary care physician within the specified time period |
| Average Health Care Spending | 30, 60, 90, 180, and 360 days | Health care expenditures by the patient within the specified time frame |
| Average Self-reported Health Status | 30, 60, 90, 180, and 360 days | A measure of the patient's self-reported physical and mental health, as measured by a shorter, modified version of the Short Form (SF)-36 |
| Average of Disease Specific Outcomes | 30, 60, 90, 180, and 360 days | Depending on the clinical information that is captured, disease specific clinical outcomes (e.g. prevalence of hypertension; HbA1C levels) will also be reported |
Countries
United States
Outcome results
None listed