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

项目总结/摘要 我们的UCLA团队与United Healthcare（UHC）合作，建议达成合作协议 与疾病预防控制中心一起评估UHC国家护理协调（NCC）计划对创新护理的影响 旨在同时解决健康的医疗，行为和社会决定因素的模式， 美国最严重的疾病和最昂贵的商业保险的人。NCC是一个真实世界的护理 协调计划，旨在提供“全人护理”，整合密集的医疗，行为和 在社区一级提供社会支持，以解决除健康的社会决定因素之外的获取障碍， 包括粮食和住房不安全。研究的总体目标是采用严格的经验主义方法， 评估这一创新计划对成人护理的提供、结果和成本的影响。 糖尿病患者的商业登记。这项拟议的评估是独一无二的，因为UHC实施了一项 2015年至今NCC项目的务实、随机对照试验。 该项目的具体目标如下：目标1将评估UHC的NCC计划是否能减少 在高成本、高需求的商业保险受益人中，糖尿病患者的使用率将降低 糖尿病并发症这些措施包括主要的心血管事件，减少急诊室就诊， 住院治疗，降低总体护理成本（主要终点），减少截肢，减缓 慢性肾脏疾病和A1 c控制改善和药物依从性改善， 糖尿病护理过程（次要终点）。目标2将评估净捐助国对发展中国家的影响， 糖尿病受益人的三个主要终点因种族或民族而异。目标3将比较 NCC在降低护理和利用成本、特定急诊室就诊和 糖尿病患者和非糖尿病患者的住院率。目标4是参与一个协作的多- 机构网络，旨在加强评估自然实验的研究方法， 地点，并推进美国研究界自然实验的最佳分析方法。 我们与UHC长达15年的高效合作，使得拟议的研究很可能 分析这一务实的随机对照试验将是成功的，并将提供急需的证据， 密集的，全人护理管理计划可以减少糖尿病相关并发症，资源 利用率，和成本的一些最脆弱的商业保险的糖尿病患者在美国。

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.