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From Camden to Memphis: Recent complex care randomized controlled trials present a call to action

A. Hamblin, R. Davis
Center for Health Care Strategies Blog

In early 2020, the field of complex care has seen at least two new robust additions to the evidence base. First, the field was immersed in pondering the implications of the recent New England Journal of Medicine publication of the Camden Coalition’s randomized controlled trial (RCT) results — results which, at a high level, revealed no impact on 180-day hospital readmissions, the primary measure of interest. And just last week, the American Journal of Managed Care reported the findings of a CareMore RCT in Memphis — in this case, with favorable reductions in total medical expenditure and inpatient utilization.

Whereas the Camden results sent health care stakeholders (including ourselves) into a flurry of nuanced self-reflection about how much we still have to learn in this field, the Memphis results might be seen as a sigh of relief — that indeed complex care has been onto something all these years. However, it’s the two studies in combination that present the real contribution to the field — and the real call to action for the rest of us in terms of where to go next with this work. Collectively, these two studies highlight distinct approaches to identifying and coordinating care for two very different populations — not to mention two distinct approaches to studying their impacts. As such, taken together, these studies underscore the imprecision of the term “complex care,” and the compelling need for the field to sharpen everything from its language to its identification algorithms, intervention approaches and measurement strategies. Without CareMore’s study, we might have grown overly skeptical about the potential for these programs based on the Camden RCT. However, without Camden, we would very likely have over-generalized the success of the Memphis experience — particularly given how much we all love a success story. The clearest call to action comes from interpreting them together, and considering what they tell us in combination.

Hamblin A, Davis R. From Camden to Memphis: Recent Complex Care Randomized Controlled Trials Present a Call to Action. Center for Health Care Strategies Blog; February 20, 2020. Available online.

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