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The Impact of Comprehensive Case Management on HIV Client Outcomes.

ABSTRACT: In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM), for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment). Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500). When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of HIV.

SUBMITTER: Brennan-Ing M

PROVIDER: S-EPMC4744022 | biostudies-other | 2016

REPOSITORIES: biostudies-other

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Project description:Interventions: The recruitment process will follow 2 ways: 1.Based on the characterization, the target population recorded in the database of the insurance health company will be invited to participate until the estimated sample size is completed. 2. During the hospitalization the patients can be detected and invited to participate into the study. In both, the informed consent will be a prior and required procedure. The study will assess the outcomes in the same group of patients before and after intervention. The intervention follows the next steps: 1. Case detection: Identifying if the patient suffers from multiple diseases, if there are readmissions and high demand for health services during hospital stay or according to the reports of the health promoting entity (EPS in Spanish). 2. Case screening: assessing complexity INTERMED scale (European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatic), medium-high or high). 3. To establish the baseline measurement of indicators to comparate during post-intervention. 4. Comprehensive and multidimensional assessment of the patient: identifying care needs. 5. Assessment of caregiver burden: identifying fatigue and general health status. 6. Personalized care plan: a comprehensive and individual plan is made for each case according to the needs detected. 7. Coordination between providers: contacts and procedures to secure referral to service providers as required by the patient and the family caregiver. 8. Monitoring and evaluation of the personalized plan.;Comprehensive Health Care;Patient Care Management;Long-Term Care;Delivery of Health Care ;Progressive Patient Care;Caregivers Primary outcome(s): 1. Demand for health care services. (Frequency of use of health services for causes related to multi-pathological clinical categories, Measurement tool: Patients Database). Measurement time: At baseline and, 6 months. 2. Admission and re-admission (Frequency of unscheduled admissions and re-admissions related to multi-pathological clinical categories, Measurement tool: Patients Database). Measurement time: At baseline and, 6 months. 3. Pharmaceutical prescription (Medications prescribed to the patient,Measurement tool: drug-dispending database). Measurement time: At baseline and, 6 months. Study Design: Allocation: Non-randomized controlled trial. Masking: Open. Control group: Historical. Assignment: Single group. Purpose: Prevention

Project description:IntroductionEvidence indicates children who suffer from ill-health are less likely to attend or complete schooling. Malaria is an important cause of morbidity and mortality in school-age children. However, they are less likely to receive malaria treatment at health facilities and evidence for how to improve schoolchildren's access to care is limited. This study aimed to evaluate the impact of a programme of school-based malaria case management on schoolchildren's attendance, health and education.MethodsA cluster randomised controlled trial was conducted in 58 primary schools in Zomba District, Malawi, 2011-2015. The intervention, implemented in 29 randomly selected schools, provided malaria rapid diagnostic tests and artemisinin-based combination therapy to diagnose and treat uncomplicated malaria as part of basic first aid kits known as 'Learner Treatment Kits' (LTK). The primary outcome was school attendance, assessed through teacher-recorded daily attendance registers and independent periodic attendance spot checks. Secondary outcomes included prevalence of Plasmodium spp infection, anaemia, educational performance, self-reported child well-being and health-seeking behaviour. A total of 9571 children from standards 1-7 were randomly selected for assessment of school attendance, with subsamples assessed for the secondary outcomes.ResultsBetween November 2013 and March 2015, 97 trained teachers in 29 schools provided 32 685 unique consultations. Female schoolchildren were significantly more likely than male to seek a consultation (unadjusted OR=1.78 (95% CI 1.58 to 2.00). No significant intervention effect was observed on the proportion of child-days recorded as absent in teacher registers (n=9017 OR=0.90 (95% CI 0.77 to 1.05), p=0.173) or of children absent during random school visits-spot checks (n=5791 OR=1.09 (95% CI 0.87 to 1.36), p=0.474). There was no significant impact on child-reported well-being, prevalence of Plasmodium spp, anaemia or education scores.ConclusionDespite high community demand, the LTK programme did not reduce schoolchildren's absenteeism or improve health or education outcomes in this study setting.Trial registration numberClinicalTrials.gov NCT02213211.

Project description:BackgroundSome health care systems have set up referral trauma centers to centralize expertise to improve trauma management. There is scant and controversial evidence regarding the impact of provider's volume on the outcomes of trauma management.ObjectiveTo evaluate the impact of hospital volume on the outcomes of renal trauma management in a European health care system.Design setting and participantsA retrospective multicenter study, including all patients admitted for renal trauma in 17 French hospitals between 2005 and 2015, was conducted.InterventionNephrectomy, angioembolization, or nonoperative management.Outcome measurements and statistical analysisFour quartiles according to the caseload per year: low volume (eight or fewer per year), moderate volume (nine to 13 per year), high volume (14-25/yr), and very high volume (≥26/yr). The primary endpoint was failure of nonoperative management defined as any interventional radiology or surgical procedure needed within the first 30 d after admission.Results and limitationsOf 1771 patients with renal trauma, 1704 were included. Nonoperative management was more prevalent in the very-high- and low-volume centers (p = 0.02). In a univariate analysis, very high hospital volume was associated with a lower risk of nonoperative management failure than low (odds ratio [OR] = 0.54; p = 0.05) and moderate (OR = 0.48; p = 0.02) hospital volume. There were fewer nephrectomies in the high- and very-high-volume groups (p = 0.003). In a multivariate analysis, very high volume remained associated with a lower risk of nonoperative management failure than low (OR = 0.48; p = 0.04) and moderate (OR = 0.42; p = 0.01) volume. Study limitations include all the shortcomings inherent to its retrospective multicenter design.ConclusionsIn this multicenter study, management of renal trauma varied according to hospital volume. There were lower rates of nephrectomy and failure of nonoperative management in very-high-volume centers. These results raise the question of centralizing the management of renal trauma, which is currently not the case in our health care system.Patient summaryIn this study, management of renal trauma varied according to hospital volume. Very-high-volume centers had lower rates of nephrectomy and failure of nonoperative management.

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The Impact of Comprehensive Case Management on HIV Client Outcomes.

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