A Pragmatic Nationwide RCT of Coordinated Medical, Behavioral, and Social Services to Improve Care and Utilization among High-Cost, High-Need Insured Patients with Diabetes

一项务实的全国性随机对照试验，协调医疗、行为和社会服务，以改善高成本、高需求的糖尿病患者的护理和利用

基本信息

批准号：
10625400
负责人：
OBIDIUGWU KENRIK, DURU
金额：
$ 45.75万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-30 至 2025-09-29
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10625400
关键词：
Pragmatic Nationwide RCT Coordinated Medical

项目摘要

PROJECT SUMMARY/ABSTRACT Our UCLA team, in partnership with United Healthcare (UHC), proposes to form a cooperative agreement with the CDC to evaluate the impact of a UHC national care coordination (NCC) program with innovative care models designed to simultaneously address the medical, behavioral and social determinants of health among the most severely ill and costly commercially insured persons in the US. The NCC is a real-world care coordination program that aims to provide “whole-person care,” integrating intensive medical, behavioral and social support at a community level to address access barriers in addition to social determinants of health, including food and housing insecurity. The overall goal of the research is to employ rigorous empirical evaluation of the impact of this innovative program on the delivery, outcomes, and cost of care for adult commercial enrollees with diabetes. This proposed evaluation is unique because UHC implemented a pragmatic, randomized control trial of the NCC program in 2015 to the present. The specific aims for this project are as follows: Aim 1 will evaluate whether UHC's NCC program to reduce utilization among high-cost, high-need commercially insured beneficiaries with diabetes will lead to reduced diabetes complications. These include major cardiovascular events, fewer emergency room visits and hospitalizations, lower overall costs of care (primary endpoints), reduced amputations, slower progression of chronic kidney disease and improvements in A1c control and improvements in adherence to medications and diabetes processes of care (secondary endpoints). Aim 2 will evaluate whether the influence of the NCC on the three primary endpoints for beneficiaries with diabetes varies by race or ethnicity. Aim 3 will compare the relative effectiveness of the NCC on reducing costs of care and utilization, specific emergency room visits and hospitalizations, among beneficiaries with and without diabetes. Aim 4 is to participate in a collaborative multi- institution network designed to strengthen the research methods for evaluating natural experiments across all sites, and to advance the best analytic methods for natural experiments in the US research community. Our 15 year, highly productive collaboration with UHC makes it very likely that the proposed research analyzing this pragmatic RCT will be successful and will provide critically needed evidence about whether intensive, whole-person care management programs can reduce diabetes related complications, resource utilization, and costs for some of the most vulnerable commercially insured persons with diabetes in the US.

项目摘要/摘要我们的加州大学洛杉矶分校团队与联合医疗保健（UHC）合作，构成合作协议的提案借助CDC评估UHC国家护理协调（NCC）计划的影响旨在简单地解决健康，行为和社会决定者的模型在美国，最严重的商业保险人。 NCC是现实世界的护理协调计划旨在提供“全人保健”，整合密集的医疗，行为和除了健康的社会决定者之外包括食物和住房不安全感。该研究的总体目标是采用严格的经验评估该创新计划对成人交付，成果和护理成本的影响商业注册糖尿病。该提出的评估是独一无二的，因为UHC实施了 NCC计划在2015年的务实，随机对照试验至现在。该项目的具体目的如下：AIM 1将评估UHC的NCC计划是否减少高成本的高成本商业保险受益人的利用率将导致减少糖尿病并发症。其中包括重大的心血管活动，急诊室访问较少以及住院，降低总体护理成本（主要终点），截肢减少，进展较慢慢性肾脏疾病以及A1C控制的改善以及遵守药物和糖尿病护理过程（次要终点）。 AIM 2将评估NCC的影响是否糖尿病受益人的三个主要终点因种族或种族而异。 AIM 3将比较 NCC对降低护理和利用成本的相对有效性，特定的急诊室就诊和在患有和没有糖尿病的受益人中，住院。 AIM 4是参加协作的多机构网络旨在加强用于评估所有自然实验的研究方法站点，并推进美国研究界自然实验的最佳分析方法。我们与UHC高产的15年合作使拟议的研究很有可能分析此务实的RCT将是成功的，并将提供有关是否是否存在的证据密集的全人护理管理计划可以减少糖尿病相关的并发症，资源在美国，一些最脆弱的商业保险人的利用和成本。