Dr. Jeffrey Brenner and Camden Coalition Staff

Camden Coalition hits enrollment mark in randomized controlled trial

Care Team celebrates milestone

Members of the care management team at the Camden Coalition have reached the milestone of enrolling 857 patients in our first randomized controlled trial (RCT), a major step in our efforts to rigorously evaluate the impact of the care we provide to patients with complex needs in Camden.

The study, launched in partnership with health economists at MIT’s Abdul Latif Jameel Poverty Action Lab (J-PAL) in 2014, examines the effect of our Care Management Initiatives on our participants’ hospital readmission and emergency room visit rates, compared to those of a control group receiving routine care. Randomized evaluations are the most rigorous and unbiased method of testing a program’s impact.

“We want to ensure that our care coordination model is measurably improving the quality of life of the patients we serve and reducing the likelihood of costly hospitalizations,” said Aaron Truchil, Director of Strategy and Analytics for the Camden Coalition. “Through our years of work with complex patients, we’ve seen lots of profoundly powerful cases where our model has made a dramatic influence in a patient’s life. We hope that the Coalition’s RCT can demonstrate in the aggregate that our participants are living longer, healthier lives and experiencing fewer preventable hospitalizations and emergency room visits after graduating from our program.”

Our randomized evaluation comes at a time when policy makers, health care leaders, advocates, and consumers are increasingly calling for solutions to cut health care costs while improving the quality of health care delivery. Given that 5 percent of the U.S. population accounts for more than half of health care expenditures, more attention has been focused on care management interventions that serve patients with complex needs who are frequently hospitalized.

But despite the attention, “there is a paucity of rigorous evaluation of care interventions for patients with complex needs. Some are out there, but the majority of them aren’t randomized evaluations. RCTs are the simplest, most straightforward way of showing program impact. We want to be a model of rigorous evaluation practices and encourage other groups to do the same,” said Aaron. “The Camden Coalition is the first U.S. partner organization selected to partner with J-PAL’s new North America office. Historically, J-PAL’s work has focused largely on doing RCTs on poverty-related programs abroad.”

Noted MIT economist Amy Finkelstein and her colleagues are following our participants’ subsequent hospital utilization for up to a year after they graduate from our program to examine the effects of our intervention on their health outcomes, usage of health care services, and health care cost. The research team is collecting outcome data through the Camden Coalition Health Information Exchange (HIE) and Camden ARISE, as well as mortality data from the Centers for Disease Control and Prevention. Results of the study are projected to be available in late 2018.

 

Seeing the person, not the diagnosis

This “gold-standard” study tests the effectiveness of our model of healthcare hotspotting, which we pioneered in Camden. Using real-time hospital data from our Camden HIE, our care management team flags eligible candidates–specifically, adults with two or more hospitalizations in the past six months and two or more chronic conditions, and who are taking five or more medications–and sends hospital-based enrollment staff to their bedside. There, our enrollment staff tell the patient about our care management program and RCT. Patients who choose to participate in the program are then randomly divided into a treatment group who receives the care management intervention or a control group who is not enrolled in the program.

Within 72 hours after they are discharged from the hospital, enrolled patients meet with a dedicated team of registered and licensed practical nurses, social workers, and community health workers who empower them to address their own medical issues and behavioral and social barriers to wellness. Our care team connects patients to primary care, transportation, and housing services, and helps them enroll in social service programs in their community. They engage with them in their homes on a regular basis, reconcile their medications, develop a customized care plan centered on goals identified by the patient, and accompany patients to doctor visits. The end goal: to help patients acquire the skills and support they need to avoid preventable hospital readmissions and improve their wellbeing. Participants typically graduate from the program in about 90 days. See how our complex care model works.

“When we first meet with a patient, we say, ‘Tell me who you are. Tell me how your life might be different if you were healthy.’ We see the person, not the diagnosis. As the intervention goes on, it’s about building a relationship with them, showing empathy and earning their trust,” said Jeneen Skinner, Clinical Manager of Community Operations for the Camden Coalition. “It’s helped me see things a lot differently working here as a nurse and as a human being. You find that people have not had anyone to really listen to them. We’ve been able to create authentic healing relationships with our patients, and I think that’s what helps make the difference in their recovery.”

 

Bringing our model into the standard of care

We hope that this study will help us refine our collaborative care model here in Camden so we can best serve patients with complex health and social needs, address their root causes of extreme health care utilization, and share our knowledge and experience with communities across the country. In Camden, 29 percent of health care costs can be attributed to just 1 percent of patients, and 20 percent of patients account for 84 percent of hospital receipts. Similar patterns of high utilization among a small subset of the patient population can be found nationally, where an estimated 5 percent of the population account for over 50 percent of health care costs.

“Our goal is to provide care that is backed by the highest standards of evidence,” said Aaron. “We function as a research and development organization, and this RCT will give us valuable information about what’s working in our intervention and what isn’t.”

“It’s a landmark moment in the Coalition’s evolution,” he added. “Camden can be a model for the rest of the country in delivering better care at lower cost for patients with complex needs. We’re hopeful that the RCT results will make the case for bringing our model to scale so it can be part of the standard of care.”

Posted: October 11, 2017