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Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial
IMPORTANCE: Medicaid spending on children and young adults with chronic disease could be decreased through care coordination programs by reducing unnecessary hospital and emergency care. OBJECTIVE: To assess whether a comprehensive care coordination program reduces Medicaid expenditures by decreasin...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784784/ https://www.ncbi.nlm.nih.gov/pubmed/31584682 http://dx.doi.org/10.1001/jamanetworkopen.2019.12604 |
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author | Caskey, Rachel Moran, Kellyn Touchette, Daniel Martin, Molly Munoz, Garret Kanabar, Pinal Van Voorhees, Benjamin |
author_facet | Caskey, Rachel Moran, Kellyn Touchette, Daniel Martin, Molly Munoz, Garret Kanabar, Pinal Van Voorhees, Benjamin |
author_sort | Caskey, Rachel |
collection | PubMed |
description | IMPORTANCE: Medicaid spending on children and young adults with chronic disease could be decreased through care coordination programs by reducing unnecessary hospital and emergency care. OBJECTIVE: To assess whether a comprehensive care coordination program reduces Medicaid expenditures by decreasing hospital and emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial included 6259 children and young adults with chronic disease who received public insurance through Illinois Medicaid. In April 2016, eligible youth were randomized to receive comprehensive care coordination through the Coordinated Healthcare for Complex Kids (CHECK) program (n = 3126) or usual care (n = 3119) to measure the effect of the CHECK program on Medicaid expenditures and health care utilization using a difference-in-differences (DID) approach. Data were collected from May 1, 2014, to April 30, 2017, and analyzed in May 2018. INTERVENTIONS: Care coordination, mental health care, education, and social support were provided to CHECK participants and their family members. Services were tailored based on family and participant need. MAIN OUTCOMES AND MEASURES: Mean annual Medicaid expenditures, mean annual health care utilization by category (ED and inpatient), and chronic disease type and risk level. RESULTS: A total of 6259 participants (mean [SD] age, 11.3 [6.4] years; 2918 [46.6%] female; 2594 [41.4%] with medium and high risk) were randomized. Following the exclusion of 14 outliers, 6245 participants were analyzed. The mean (SD) annual Medicaid expenditure before the intervention was $1633 ($4006) for the intervention group and $1703 ($4466) for the usual care group, which decreased to a mean (SD) of $1341 ($3004) and $1413 ($3785), respectively, after the intervention (DID, −$1; 95% CI, −$199 to $196; P = .99). The mean (SD) inpatient utilization before the intervention was 63.0 (344.4) per 1000 person-years (PYs) for the intervention group and 69.3 (370.9) per 1000 PYs for the usual care group, which decreased to 43.5 (297.2) per 1000 PYs and 47.8 (304.9) per 1000 PYs, respectively, after the intervention (DID, 2.0; 95% CI, −17.9 to 21.8; P = .85). Among participants with asthma, those in the intervention group had a greater mean (SD) decrease in ED utilization compared with usual care, but the difference was not significant (−225.9 [65.3] vs −104.5 [80.0] visits per 1000 PY; DID, −121.5; 95% CI, −268.9 to 26.0; P = .11). Similarly, enrolled participants with sickle cell disease had a smaller but not significant mean (SD) increase in ED utilization compared with usual care (583.3 [839.0] vs 3761.9 [4611.2] visits per 1000 PYs; DID, −3178.6; 95% CI, −10 724.3 to 4367.2; P = .41). CONCLUSIONS AND RELEVANCE: Overall Medicaid expenditures and health care utilization (hospital and ED) decreased similarly for both CHECK participants and the usual care group. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04057521 |
format | Online Article Text |
id | pubmed-6784784 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-67847842019-10-25 Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial Caskey, Rachel Moran, Kellyn Touchette, Daniel Martin, Molly Munoz, Garret Kanabar, Pinal Van Voorhees, Benjamin JAMA Netw Open Original Investigation IMPORTANCE: Medicaid spending on children and young adults with chronic disease could be decreased through care coordination programs by reducing unnecessary hospital and emergency care. OBJECTIVE: To assess whether a comprehensive care coordination program reduces Medicaid expenditures by decreasing hospital and emergency department (ED) utilization. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial included 6259 children and young adults with chronic disease who received public insurance through Illinois Medicaid. In April 2016, eligible youth were randomized to receive comprehensive care coordination through the Coordinated Healthcare for Complex Kids (CHECK) program (n = 3126) or usual care (n = 3119) to measure the effect of the CHECK program on Medicaid expenditures and health care utilization using a difference-in-differences (DID) approach. Data were collected from May 1, 2014, to April 30, 2017, and analyzed in May 2018. INTERVENTIONS: Care coordination, mental health care, education, and social support were provided to CHECK participants and their family members. Services were tailored based on family and participant need. MAIN OUTCOMES AND MEASURES: Mean annual Medicaid expenditures, mean annual health care utilization by category (ED and inpatient), and chronic disease type and risk level. RESULTS: A total of 6259 participants (mean [SD] age, 11.3 [6.4] years; 2918 [46.6%] female; 2594 [41.4%] with medium and high risk) were randomized. Following the exclusion of 14 outliers, 6245 participants were analyzed. The mean (SD) annual Medicaid expenditure before the intervention was $1633 ($4006) for the intervention group and $1703 ($4466) for the usual care group, which decreased to a mean (SD) of $1341 ($3004) and $1413 ($3785), respectively, after the intervention (DID, −$1; 95% CI, −$199 to $196; P = .99). The mean (SD) inpatient utilization before the intervention was 63.0 (344.4) per 1000 person-years (PYs) for the intervention group and 69.3 (370.9) per 1000 PYs for the usual care group, which decreased to 43.5 (297.2) per 1000 PYs and 47.8 (304.9) per 1000 PYs, respectively, after the intervention (DID, 2.0; 95% CI, −17.9 to 21.8; P = .85). Among participants with asthma, those in the intervention group had a greater mean (SD) decrease in ED utilization compared with usual care, but the difference was not significant (−225.9 [65.3] vs −104.5 [80.0] visits per 1000 PY; DID, −121.5; 95% CI, −268.9 to 26.0; P = .11). Similarly, enrolled participants with sickle cell disease had a smaller but not significant mean (SD) increase in ED utilization compared with usual care (583.3 [839.0] vs 3761.9 [4611.2] visits per 1000 PYs; DID, −3178.6; 95% CI, −10 724.3 to 4367.2; P = .41). CONCLUSIONS AND RELEVANCE: Overall Medicaid expenditures and health care utilization (hospital and ED) decreased similarly for both CHECK participants and the usual care group. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04057521 American Medical Association 2019-10-04 /pmc/articles/PMC6784784/ /pubmed/31584682 http://dx.doi.org/10.1001/jamanetworkopen.2019.12604 Text en Copyright 2019 Caskey R et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Caskey, Rachel Moran, Kellyn Touchette, Daniel Martin, Molly Munoz, Garret Kanabar, Pinal Van Voorhees, Benjamin Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title | Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title_full | Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title_fullStr | Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title_full_unstemmed | Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title_short | Effect of Comprehensive Care Coordination on Medicaid Expenditures Compared With Usual Care Among Children and Youth With Chronic Disease: A Randomized Clinical Trial |
title_sort | effect of comprehensive care coordination on medicaid expenditures compared with usual care among children and youth with chronic disease: a randomized clinical trial |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784784/ https://www.ncbi.nlm.nih.gov/pubmed/31584682 http://dx.doi.org/10.1001/jamanetworkopen.2019.12604 |
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