Addressing Basic Needs to Improve Diabetes Outcomes in Medicaid Beneficiaries

2型糖尿病影响着超过2900万美国成年人，低血糖患者承担的疾病负担不成比例。 收入人口。有效的自我管理需要关注、规划、贯彻和始终如一 采取多种健康行为，以防止负面的健康结果。对于低收入人群， 然而，健康的改善往往被满足食物，住房， 人身安全和生活必需品基本需求得不到满足会损害一个人的能力， 保持健康行为。我们之前的研究表明，随着基本需求得不到满足，低- 有收入个人甚至不太可能记得，更不用说根据转诊采取行动，获得所需的保健服务。 然而，当未满足的需求得到解决和/或人们有个人导航器来帮助时， 对健康转诊采取行动的情况显著增加。传统上，患者导航器帮助协调护理， 管理疾病或促进筛查和预防行为。我们建议扩大这一作用， 识别和解决未满足的基本需求，我们希望这将促进行为改变和改善 健康成果。我们将在一项与以下机构合作进行的务实的随机试验中测试这种方法： 路易斯安那州医疗保健连接，路易斯安那州最大的医疗补助管理式医疗计划。我们特别 我提出了一个多学科，多方法的研究，有三个目标：使用观察方法，我们将 检查医疗补助成员经历的基本需求的类型和数量，以及这些需求如何 通过将基本需求数据与索赔数据联系起来，随着时间的推移影响健康结果和医疗保健利用率 (Aim 1）。在一项实用的随机试验中，我们将测试有效性（目标2）和成本效益（目标 3)在500名成年人（18-75岁）中， 医疗补助，2型糖尿病，和1个或多个未满足的基本需求。主要假设是， 与常规治疗相比，受试者治疗前后HbA 1c降低幅度更大（M=0.5%） 参与者根据我们关于未满足的基本需求对健康结果的影响的概念模型， 我们还将检查自我护理的障碍（例如，注意力、压力、睡眠），健康行为（例如，葡萄糖 监测、饮食、临床筛查）和次级健康结果（例如，急诊科 利用率、住院率、生活质量）。路易斯安那州医疗保健连接将确定合格的成员， 研究招聘并提供6个月的基本需求导航。研究小组将招募，登记， 在基线和3个月、6个月和12个月随访时随机化并通过电话调查研究参与者。所有 HbA 1c数据将从基线前1-3个月至12个月的电子病历中获得 以评估变化。如果干预措施有效且具有成本效益， 通过路易斯安那州医疗保健连接的母公司，Centene公司， 它是美国最大的医疗补助管理医疗公司，与其他28个州的医疗补助计划合作。

Type 2 diabetes affects over 29 million US adults, with a disproportionate burden of disease borne by low- income populations. Effective self-management requires attention, planning, follow-through and consistent performance of multiple health behaviors to prevent negative health outcomes. For low-income individuals, though, health improvement is often superseded by the drive to fulfill basic needs such as food, housing, personal safety, and money for necessities. Having unmet basic needs overwhelms a person’s ability to maintain health behaviors. Our prior research has demonstrated that with more unmet basic needs, low- income individuals are less likely to even remember let alone act on a referral for needed health services. However, when unmet needs are resolved and/or people have a personal navigator to help, the likelihood of acting on a health referral significantly increases. Traditionally, patient navigators help coordinate care, manage disease or promote screening and preventive behaviors. We propose expanding this role to include identifying and resolving unmet basic needs, which we expect will facilitate behavior change and improve health outcomes. We will test this approach in a pragmatic randomized trial conducted in partnership with Louisiana Healthcare Connections, the largest Medicaid managed care plan in Louisiana. Specifically, we propose a multi-disciplinary, multi-method study with three aims: Using observational methods, we will examine the type and number of basic needs experienced by Medicaid members, and how those needs impact health outcomes and healthcare utilization over time by linking basic needs data with claims data (Aim 1). In a pragmatic randomized trial, we will test the effectiveness (Aim 2) and cost-effectiveness (Aim 3) of a basic needs navigation intervention compared to usual care among 500 adults (ages 18-75) with Medicaid, type 2 diabetes, and 1 or more unmet basic needs. The primary hypothesis is that intervention participants will have a greater reduction (M=0.5%) in HbA1c pre-post compared with usual care participants. Consistent with our conceptual model of the effects of unmet basic needs on health outcomes, we also will examine barriers to self-care (e.g., attention, stress, sleep), health behaviors (e.g., glucose monitoring, diet, clinical screenings) and secondary health outcomes (e.g., emergency department utilization, hospitalization, quality of life). Louisiana Healthcare Connections will identify eligible members for study recruitment and provide basic needs navigation for 6 months. The research team will recruit, enroll, randomize, and survey study participants by phone at baseline and 3-, 6- and 12-month follow up. All HbA1c data will be obtained from electronic medical records between 1-3 months pre-baseline and 12 months post-baseline to assess change. If effective and cost-effective, the intervention has an accelerated path to wide diffusion through Louisiana Healthcare Connections’ parent company, Centene Corporation, which is the largest Medicaid managed care company in the U.S., with Medicaid plans in 28 other states.