Albert W Wu1, Christine M Weston2, Chidinma A Ibe3, Claire F Ruberman4, Lee Bone5, Romsai T Boonyasai6, Sandra Hwang2, Janice Gentry7, Leon Purnell8, Yanyan Lu9, Shuwen Liang9, Michael Rosenblum4. 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: awu@jhu.edu. 2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 4. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. Biddle Broadway, North Avenue, Chester Support Council, Baltimore, Maryland. 8. Men and Families Center, Baltimore, Maryland. 9. Johns Hopkins HealthCare LLC, Glen Burnie, Maryland.
Abstract
INTRODUCTION: This cluster RCT aimed to reduce healthcare utilization and increase the referral of patients between an academic health center and local community-based organizations (CBOs) that address social determinants of health. STUDY DESIGN: Cluster RCT. SETTINGS/PARTICIPANTS: Twenty-two CBOs located in Baltimore, Maryland, were randomly assigned to the intervention or control group, and 5,255 patients were allocated to the intervention or control group based on whether they lived closer to an intervention or control CBO. Data were collected in 2014-2016; the analysis was conducted in 2016. INTERVENTION: A multicomponent intervention included an online tool to help refer clients to community resources, meet-and-greet sessions between CBO staff and healthcare staff, and research assistants. MAIN OUTCOME MEASURES: The primary outcomes were patient emergency department visits and days spent in the hospital. Additional outcomes for CBO clients included knowledge of other CBOs, number of referrals to CBOs by the healthcare system, and number of referrals to healthcare system by CBOs. Outcomes for CBO staff included the number of referrals made to and received from the healthcare system and the number of referrals made to and received from other CBOs. RESULTS: There was no significant effect of the intervention on healthcare utilization outcomes, CBO client outcomes, or CBO staff outcomes. Ancillary analyses demonstrated a 2.9% increase in referrals by inpatient staff to intervention CBOs (p=0.051) and a 6.6% increase in referrals by outpatient staff to intervention CBOs between baseline and follow-up (p=0.027). Outpatient staff reported a significant reduction in barriers related to the lack of information about CBO services (-18.3%, p=0.004) and an increase in confidence in community resources (+14.4%, p=0.023) from baseline to follow-up. CONCLUSIONS: The intervention did not improve healthcare utilization outcomes but was associated with increased healthcare staff knowledge of, and confidence in, local CBOs. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02222909.
RCT Entities:
INTRODUCTION: This cluster RCT aimed to reduce healthcare utilization and increase the referral of patients between an academic health center and local community-based organizations (CBOs) that address social determinants of health. STUDY DESIGN: Cluster RCT. SETTINGS/PARTICIPANTS: Twenty-two CBOs located in Baltimore, Maryland, were randomly assigned to the intervention or control group, and 5,255 patients were allocated to the intervention or control group based on whether they lived closer to an intervention or control CBO. Data were collected in 2014-2016; the analysis was conducted in 2016. INTERVENTION: A multicomponent intervention included an online tool to help refer clients to community resources, meet-and-greet sessions between CBO staff and healthcare staff, and research assistants. MAIN OUTCOME MEASURES: The primary outcomes were patient emergency department visits and days spent in the hospital. Additional outcomes for CBO clients included knowledge of other CBOs, number of referrals to CBOs by the healthcare system, and number of referrals to healthcare system by CBOs. Outcomes for CBO staff included the number of referrals made to and received from the healthcare system and the number of referrals made to and received from other CBOs. RESULTS: There was no significant effect of the intervention on healthcare utilization outcomes, CBO client outcomes, or CBO staff outcomes. Ancillary analyses demonstrated a 2.9% increase in referrals by inpatient staff to intervention CBOs (p=0.051) and a 6.6% increase in referrals by outpatient staff to intervention CBOs between baseline and follow-up (p=0.027). Outpatient staff reported a significant reduction in barriers related to the lack of information about CBO services (-18.3%, p=0.004) and an increase in confidence in community resources (+14.4%, p=0.023) from baseline to follow-up. CONCLUSIONS: The intervention did not improve healthcare utilization outcomes but was associated with increased healthcare staff knowledge of, and confidence in, local CBOs. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02222909.
Authors: Margaret E Samuels-Kalow; Melanie F Molina; Gia E Ciccolo; Alexa Curt; Emily C Cleveland Manchanda; Nicole C de Paz; Carlos A Camargo Journal: West J Emerg Med Date: 2020-06-24
Authors: Aditi Vasan; John W Morgan; Nandita Mitra; Chang Xu; Judith A Long; David A Asch; Shreya Kangovi Journal: Health Serv Res Date: 2020-07-08 Impact factor: 3.402