The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial.

Area of Science:

• Health Services Research
• Public Health
• Health Economics

Background:

• Randomized evaluations of care management programs for high-use, high-need patients have yielded null results regarding hospital readmissions.
• Explanations for null results include flawed program theory or implementation failures.
• Understanding these factors is crucial for improving healthcare interventions.

Purpose of the Study:

• To investigate why a prominent care management program did not reduce hospital readmissions.
• To differentiate between a lack of program efficacy and implementation fidelity issues.
• To assess the program's impact on facilitating postdischarge ambulatory care.

Main Methods:

• Linked study participants to Medicaid data for 70% of the original cohort.
• Examined the program's effect on facilitating postdischarge ambulatory care, a key component of care coordination.
• Analyzed data to determine impacts on patient outcomes and healthcare utilization.

Main Results:

• The care management program significantly increased ambulatory visits by 15 percentage points within 14 days postdischarge.
• This increase in ambulatory care, particularly primary care, was sustained for 365 days.
• Despite increased ambulatory care, the program did not demonstrate a reduction in hospital readmissions.

Conclusions:

• Care coordination alone may be insufficient to reduce hospital readmissions for complex, high-need patient populations.
• Implementation fidelity is critical, but even with increased ambulatory care, readmission reduction was not achieved.
• Further research is needed to identify effective strategies for this patient group.