Integrated care for chronic conditions: a randomized care management trial

Area of Science:

• Health Services Research
• Chronic Disease Management
• Health Outcomes Research

Background:

• Healthcare systems utilize community-based strategies for managing multiple chronic conditions (MCC).
• Optimizing the translation of evidence-based integrated care models for patient-centered outcomes remains a challenge.
• Limited knowledge exists on the comparative effectiveness of different care management delivery methods.

Purpose of the Study:

• To compare the effectiveness and differential impact of three integrated care management delivery methods.
• To evaluate high-touch (in-person), high-tech (remote monitoring), and optimal discharge planning (ODP; telephonic) interventions.
• To assess effects on patient-centered outcomes including readmissions, health status, and patient activation.

Main Methods:

• A stratified randomized trial with a 2:2:1 ratio allocated participants to high-touch, high-tech, or ODP interventions.
• The study included adult Medicaid and Medicare-Medicaid beneficiaries with MCC recently discharged from hospitalization.
• Primary outcomes (90-day readmission, health status, patient activation) and secondary outcomes were assessed over 12 months.

Main Results:

• No significant difference in 90-day readmission rates was observed across the three interventions.
• Health status improved significantly over time but did not differ significantly between intervention groups.
• Patient activation showed a significant time-by-treatment interaction, with the high-touch approach demonstrating greater improvement than ODP.

Conclusions:

• Healthcare systems can implement diverse, person-centered care management approaches.
• These varied strategies can be effective without negatively impacting patient outcomes.
• The high-touch model showed a specific benefit in enhancing patient activation.