An Evaluation of the Michigan State Innovation Model in Washtenaw and Livingston Counties

This study will examine the effects of a care management program on the health and health spending outcomes of patients residing in Michigan's Washtenaw and Livingston Counties.

Study Overview

• Status: Completed
• Conditions: High Utilization of Emergency Departments
• Intervention / Treatment: Other: Care management services

Detailed Description

In 2017, the State of Michigan will offer enrollment in care management services to a set of patients in Washtenaw and Livingston Counties who are predicted to be high-frequency users of emergency departments. This is a quality improvement initiative. The Center for Healthcare Research and Transformation (CHRT) will administer this enrollment and collect patient data. The Principal Investigators will conduct a study that uses the data from this quality improvement initiative to compare the outcomes of the treatment and control groups. Specifically, the study will examine whether the care management services had an effect on the number of emergency department visits and the total healthcare spending of the patients in the treatment group.

The present study therefore is the second of two related projects - the first is the CHRT-administered random assignment and enrollment of patients into care management services. The present study is a secondary analysis of the data produced by the first project.

This Protocol Registration and Results submission refers to the secondary analysis component wherever applicable, and where not applicable, describes the information relevant to the CHRT project. For example, while the present study does not assign anyone into treatment or control groups, the Sample Description indicates "Probability Sample" to describe the way in which CHRT intends to enroll patients.

• Study Type: Observational
• Enrollment (Actual): 300

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48105
      • Center for Healthcare Research & Transformation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients who frequently use the emergency department of hospitals located in Washtenaw or Livingston Counties.

Description

Inclusion criteria:

1. reside in Washtenaw or Livingston counties or have an unknown address;
2. Have a probability of being admitted to an emergency department (ED) in Washtenaw or Livingston counties that exceeds a threshold value in a predictive model;

Exclusion criteria

1. Patients referred by a community provider
2. Patient declines to consent

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Treatment group; The set of patients in the sample who are offered enrollment in care management services.	Other: Care management services; Patients who receive care management services will interact with a care manager who will take an inventory of the patient's needs (including social determinants of health such as housing) and provide guidance about available social supports and clinical resources.
Control group; The set of patients in the sample who are not initially offered enrollment in care management services (will be offered enrollment after six months).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency department utilization	Number of emergency department visits per patient	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health care spending	Dollars of health care spending incurred by patient	6 months

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: Center for Healthcare Research and Transformation; Community Foundation of Southeast Michigan
• Investigators: Study Director: Marianne Udow-Phillips, MHSA, Center for Healthcare Research & Transformation

Publications and helpful links

General Publications

• Post B, Lapedis J, Singh K, Valenstein P, Buyuktur AG, Teske K, Ryan AM. Predictive Model-Driven Hotspotting to Decrease Emergency Department Visits: a Randomized Controlled Trial. J Gen Intern Med. 2021 Sep;36(9):2563-2570. doi: 10.1007/s11606-021-06664-1. Epub 2021 Mar 10.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2017
• Primary Completion (Actual): December 31, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: September 21, 2017
• First Submitted That Met QC Criteria: September 21, 2017
• First Posted (Actual): September 26, 2017

Study Record Updates

• Last Update Posted (Actual): May 20, 2020
• Last Update Submitted That Met QC Criteria: May 18, 2020
• Last Verified: May 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: HUM00133309

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No