May 2017 Research Round-Up

The monthly cycle of hypoglycemia: An observational claims-based study of emergency room visits, hospital admissions, and costs in a commercially insured population
S. Basu, S.A. Berkowitz, H. Seligman
Medical Care

Using claims data for close to 600,000 individuals, the authors estimate that eliminating the monthly cycle of hypoglycemia among commercially insured nonelderly adults could avert $54.1 million per year (95% confidence interval, $0.8-$204.0) in emergency department and inpatient hospitalization costs.

Social prescribing: Less rhetoric and more reality. A systematic review of the evidence
L. Bickerdike, A. Booth, P.M. Wilson, K. Farley, K. Wright
BMJ Open

This systematic review summarizes evidence on the effectiveness of UK NHS-based social prescribing programs that link patients in primary care with community sources of support. The authors conclude that despite wide implementation and advocating for social prescribing programs, current evidence fails to provide sufficient detail to judge either success or value for money.

Effect of a community health worker intervention among Latinos with poorly controlled type 2 diabetes: The Miami Healthy Heart Initiative randomized clinical trialO. Carrasquillo, C. Lebron, Y. Alonzo, H. Li, A. Chang, S. Kenya
JAMA Internal Medicine

This RCT of 300 Latino adults tested the impact of a 1-year Community Health Worker (CHW) intervention in which CHWs provided assistance with nonmedical services (e.g., housing, employment, legal, financial and food resources) and linkages to community social service providers in addition to health education, coaching and patient navigation. The CHW intervention resulted in modest improvements in HbA1c levels, but decreases in systolic blood pressure and LDL cholesterol were less than anticipated.

Patient-centered medical home recognition and diabetes control among health centers: exploring the role of enabling services
J.M. Dobbins, N. Peiper, E. Jones, R. Clayton, L.E. Peterson, R.L. Phillips Jr
Population Health Management

This study examined relationships between Patient-Centered Medical Home (PCMH) recognition in Federally Qualified Health Centers (FQHCs) and diabetes control and whether embedded nonmedical enabling services (e.g., case management, social work, transportation) contribute to successful model implementation. PCMH recognition was associated with a 1.5% increase in the proportion of patients with controlled diabetes (B = 0.015; 95% CI 0.002, 0.027). No significant associations between enabling services and diabetes control were observed.

Vital directions for health and health care: Priorities from a national academy of medicine initiative
V.J. Dzau, M.B. McClellan, J.M. McGinnis, et al.
JAMA

In this paper summarizing 19 National Academy of Medicine–commissioned white papers on vital directions for health and health care, a panel of experts highlight the need to address the non-medical determinants of health. In particular, as part of paying for value in health care, the authors recommend removing barriers to the integration of social services with medical services, including by integrating funding stream so that Medicaid managed care plans can coordinate with social and community interventions.

Needles in a haystack: Screening and healthcare system evidence for homelessness
J.D. Fargo, A.E. Montgomery, T. Byrne, E. Brignone, M. Cusack, A.V. Gundlapalli
Studies in Health Technology & Informatics

This evaluation of a large-scale implementation of the Homelessness Screening Clinical Reminder (HSCR), a screening instrument designed to link veterans with Veterans Health Administration (VHA) homeless or social work services, found that only 2% of those screened were currently homeless or at risk of becoming so in the near future. The housing instability screen helped differentiate between those currently homeless and at risk of homelessness. Both groups had high interest in referrals to housing services (66% and 61%). Those currently experiencing homeless, however, were more likely to access homelessness services following screening and referral (61% vs. 32%).

“They’re homeless in a home”: Retaining homeless-experienced consumers in supported housing
S. Gabrielian, A.B. Hamilton, A. Alexandrino, G. Hellemann, A.S. Young
Psychological Services

This mixed methods study examined factors that differentiated individuals who retained VA Supportive Housing and those who did not. The following interrelated factors were associated with exiting supportive housing: chronic homelessness; low intrinsic motivation; unmet needs for mental health care, substance abuse treatment, and independent living skills; poor primary care engagement; frequent emergency department use; and recent mental health hospitalizations. Findings underscore the potential value of clinical interventions that address these factors.

Patients’ perspectives on care management services for complex substance use disorders
E. Hawkins, A. Lott, C. Malte, et al.
Journal of Addictive Services

This study explored patient perspectives about care management using qualitative interviews with 22 men with complex substance use disorders enrolled in a trial of a care management model that included addressing housing and other social needs. Interviews highlighted the importance of the patient-provider relationship, individual visits with providers, flexible and personalized treatment, and a focus on recovery over abstinence in promoting patient engagement in care management services. Results suggest a need for increased outreach and assistance with housing and transportation to treatment.

The impact of infant well-child care compliance and social risks on emergency department utilization
N.R. Lawson, M.D. Klein, N.J. Ollberding, V. Wurster Ovalle, A.F. Beck
Clinical Pediatrics

The authors of this study conducted a retrospective review of electronic health records from 212 consecutive newborns to examine the relationships between completed well-child visits, parent-reported social risk, and emergency department utilization in a socioeconomically-disadvantaged primary care population. A total of 73% visited the ED by 2 years of life. Sixty percent received ≥5 well-child visits by 14 months; 26% reported ≥1 social risk. No statistically significant associations between number of completed well-child visits and reported social risks or ED utilization were observed.

Providing intensive addiction/housing case management to homeless veterans enrolled in addictions treatment: A randomized controlled trial
C.A. Malte, K. Cox, A.J. Saxon
Psychology of Addictive Behaviors

This study compared addiction/housing case management (AHCM), which included individualized housing, substance use and mental health case management, life skills training and community outreach, to weekly drop-in housing support among 181 homeless veterans entering VA substance abuse treatment. Both conditions significantly increased percentage of days housed and ASI drug and psychiatric scores and alcohol/drug abstinence, with no statistically significant differences detected between conditions. Housing support group participants experienced a greater decrease in emergency department visits and a greater improvement in ASI alcohol composite scores.

Evaluating Complex Care Programs: Is it a Zero-Sum Game?
M.C. Raven, I. Romm & T. Ajayi
New England Journal of Medicine Catalyst

In this NEJM Catalyst commentary, SIREN RAC member Maria Raven and co-authors highlight the challenges of evaluating complex care interventions. They make three recommendations: allow adequate time to evaluate impact (at least 24 months), look beyond dollars to improvements in patient quality of life, and capture program effects outside of the health care sector.

Effect of an intensive outpatient program to augment primary care for high-need Veterans Affairs patients: A randomized clinical trial
D.M. Zulman, C. Pal Chee, S.C. Ezeji-Okoye, et al.
JAMA Internal Medicine

This study reports findings from a randomized clinical trial of a Veterans Affairs intensive outpatient case management and care coordination program involving a multidisciplinary team of health care and social service providers that address patients’ medical and social service needs. The intervention was well-received by a random sample of high-risk and high-cost patients, but did not reduce acute care utilization or costs when compared with standard patient-centered medical home care in the Veterans Affairs integrated system.