Specialized Community Disease Management to Reduce Substance Use and Hospital Readmissions
| Status: | Completed |
|---|---|
| Conditions: | Chronic Obstructive Pulmonary Disease, Pneumonia, Renal Impairment / Chronic Kidney Disease, Renal Impairment / Chronic Kidney Disease, Cardiology, Cardiology, Psychiatric, Pulmonary, Diabetes |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology, Nephrology / Urology, Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/12/2018 |
| Start Date: | November 18, 2014 |
| End Date: | February 28, 2017 |
This study will assess Specialized Community Disease Management (SCDM), an intervention which
employs various evidence-based strategies to engage substance using co-morbid patients while
in the hospital and follow them into the community via an empirically validated telephone
approach as well as contact with a trained community health worker peer specialist. The
investigators will first adapt and refine the core SCDM intervention with patient, provider,
and stakeholder input through an active community advisory board. The investigators will then
conduct a three-year, randomized controlled trial of 222 patients enrolled prior to hospital
discharge who are diagnosed with congestive heart failure, pneumonia, acute myocardial
infarction, chronic obstructive pulmonary disease, diabetes mellitus, or end-stage renal
disease, and a substance use disorder (SUD). Patients will be randomized to either the SCDM
intervention or Treatment as Usual (TAU), in which a team of nurse navigators and community
health workers follow patients (primarily by telephone) for 90 days post-discharge, but do
not address the specific needs of SUDs. The investigators will test the following four
hypotheses: (1) patients randomized to SCDM will demonstrate larger reductions in substance
use measured by urine-confirmed self-reported days using over the 6-month follow-up compared
to patients randomized to TAU, (2) patients randomized to SCDM will attend more specialty
substance abuse intervention and treatment sessions over the 6 month follow-up than patients
randomized to TAU, (3) patients randomized to SCDM will demonstrate reduced HIV transmission
risk behaviors and greater rates of HIV testing over the 6 month follow-up than patients
randomized to TAU, and (4) patients randomized to SCDM will experience fewer days of
rehospitalization and use of acute emergency services than patients randomized to TAU.
employs various evidence-based strategies to engage substance using co-morbid patients while
in the hospital and follow them into the community via an empirically validated telephone
approach as well as contact with a trained community health worker peer specialist. The
investigators will first adapt and refine the core SCDM intervention with patient, provider,
and stakeholder input through an active community advisory board. The investigators will then
conduct a three-year, randomized controlled trial of 222 patients enrolled prior to hospital
discharge who are diagnosed with congestive heart failure, pneumonia, acute myocardial
infarction, chronic obstructive pulmonary disease, diabetes mellitus, or end-stage renal
disease, and a substance use disorder (SUD). Patients will be randomized to either the SCDM
intervention or Treatment as Usual (TAU), in which a team of nurse navigators and community
health workers follow patients (primarily by telephone) for 90 days post-discharge, but do
not address the specific needs of SUDs. The investigators will test the following four
hypotheses: (1) patients randomized to SCDM will demonstrate larger reductions in substance
use measured by urine-confirmed self-reported days using over the 6-month follow-up compared
to patients randomized to TAU, (2) patients randomized to SCDM will attend more specialty
substance abuse intervention and treatment sessions over the 6 month follow-up than patients
randomized to TAU, (3) patients randomized to SCDM will demonstrate reduced HIV transmission
risk behaviors and greater rates of HIV testing over the 6 month follow-up than patients
randomized to TAU, and (4) patients randomized to SCDM will experience fewer days of
rehospitalization and use of acute emergency services than patients randomized to TAU.
Hospitalized patients with substance use disorders (SUDs) face significant complications in
their medical care. They are more likely to be discharged against medical advice,
rehospitalized after discharge, and experience personal chaos and reduced family support.
Hospital systems are moving to implement hospital-based and community disease management
strategies to help patients transition post-discharge, however, few provide specialized
follow-up for patients with SUDs. This proposal will test whether an extended, specialized
community disease management program can improve outcomes over an existing nurse navigator
disease management strategy for patients with co-morbid medical conditions and SUDs. The
investigators will enroll 222 inpatients with co-occurring medical conditions and SUDs and
will randomly assign them to either 1) Treatment as Usual - a 90-day, post-discharge program
that consists of medical monitoring by workers who have no special training in working with
SUD patients, or 2) the Specialized Community Disease Management program - a 90-day program
that will employ specialized teams including a trained clinical social worker and a
peer-specialist community health worker who will provide evidence-based telephone continuing
care, home visits, and increased focus on patients' substance use. All participants will be
followed at 3- and 6-months post-discharge. The investigators hypothesize that (1) patients
randomized to SCDM will demonstrate larger reductions in substance use measured by
urine-confirmed self-reported days using over the 6-month follow-up compared to patients
randomized to TAU, (2) patients randomized to SCDM will attend more specialty substance abuse
intervention and treatment sessions over the 6 month follow-up than patients randomized to
TAU, (3) patients randomized to SCDM will demonstrate reduced HIV transmission risk behaviors
and greater rates of HIV testing over the 6 month follow-up than patients randomized to TAU,
and (4) patients randomized to SCDM will experience fewer days of rehospitalization and use
of acute emergency services than patients randomized to TAU.
their medical care. They are more likely to be discharged against medical advice,
rehospitalized after discharge, and experience personal chaos and reduced family support.
Hospital systems are moving to implement hospital-based and community disease management
strategies to help patients transition post-discharge, however, few provide specialized
follow-up for patients with SUDs. This proposal will test whether an extended, specialized
community disease management program can improve outcomes over an existing nurse navigator
disease management strategy for patients with co-morbid medical conditions and SUDs. The
investigators will enroll 222 inpatients with co-occurring medical conditions and SUDs and
will randomly assign them to either 1) Treatment as Usual - a 90-day, post-discharge program
that consists of medical monitoring by workers who have no special training in working with
SUD patients, or 2) the Specialized Community Disease Management program - a 90-day program
that will employ specialized teams including a trained clinical social worker and a
peer-specialist community health worker who will provide evidence-based telephone continuing
care, home visits, and increased focus on patients' substance use. All participants will be
followed at 3- and 6-months post-discharge. The investigators hypothesize that (1) patients
randomized to SCDM will demonstrate larger reductions in substance use measured by
urine-confirmed self-reported days using over the 6-month follow-up compared to patients
randomized to TAU, (2) patients randomized to SCDM will attend more specialty substance abuse
intervention and treatment sessions over the 6 month follow-up than patients randomized to
TAU, (3) patients randomized to SCDM will demonstrate reduced HIV transmission risk behaviors
and greater rates of HIV testing over the 6 month follow-up than patients randomized to TAU,
and (4) patients randomized to SCDM will experience fewer days of rehospitalization and use
of acute emergency services than patients randomized to TAU.
Inclusion Criteria:
- patient is 18 years or older
- alcohol and/or drug screening score that indicates at least mild problem severity
Exclusion Criteria:
- medical or psychiatric complications
- patient was admitted to hospital directly from a drug and alcohol inpatient
rehabilitation facility
- patient reports plans to leave the area within the next 12 months
- patient is unable to provide valid informed consent
- patient is attending dialysis
- patient is not English-speaking
We found this trial at
1
site
3401 N Broad St
Philadelphia, Pennsylvania
Philadelphia, Pennsylvania
(215) 707-2000
Principal Investigator: Mary F Morrison, MD
Phone: 215-707-8688
Temple University Hospital On January 18, 1892 a three-story house at 3403 North Broad Street...
Click here to add this to my saved trials
