RECRUITING

Improving Care Transitions for Medicaid Insured Individuals With Co-occurring Serious Mental Illness

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

This study aims to evaluate the THRIVE clinical pathway at HUP, focusing on supporting Medicaid-insured individuals, including those with serious mental illness, following hospitalization. The study will assess clinician/administrator perspectives on the pathway's feasibility, appropriateness, and acceptability and analyze referral patterns and post-discharge outcomes. The objectives are: 1. To conduct a qualitative study evaluating the implementation of THRIVE, particularly its adaptation to include patients with serious mental illness. 2. To examine referral patterns, 30-day readmission rates, and ED utilization for THRIVE participants, comparing them with those receiving standard care. Participants will be referred to home care services during hospitalization and seen by a home care nurse within 48 hours post-discharge. A discharging physician or Advanced Practice Provider will oversee care for 30 days or until a primary care or specialist visit. The Care Coordination Team will hold weekly case conferences for 30 days post-discharge to address both health and mental health needs. The study will compare outcomes of Medicaid-insured patients, including those with serious mental illness, to those receiving usual care.

Official Title

An Equity-focused Intervention to Improve Care Transitions for Medicaid Insured Individuals With Co-occurring Chronic Medical Conditions and Serious Mental Illness

Quick Facts

Study Start:2024-04-15
Study Completion:2026-10-01
Study Type:Not specified
Phase:Not Applicable
Enrollment:Not specified
Status:RECRUITING

Study ID

NCT06203509

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years
Sexes Eligible for Study:ALL
Accepts Healthy Volunteers:Yes
Standard Ages:ADULT, OLDER_ADULT
Inclusion CriteriaExclusion Criteria
  1. * Medicaid insured
  2. * Residing in the state of Pennsylvania
  3. * Experienced a hospitalization at study hospital
  4. * Agrees to home care at partner home care setting.
  1. * Individuals under age 18

Contacts and Locations

Study Contact

Jacqueline M Brooks Carthon, PhD,RN
CONTACT
2158988050
jmbrooks@nursing.upenn.edu
Erin Babe, MPH
CONTACT
2158984417
erinbabe@nursing.upenn.edu

Principal Investigator

Jacqueline M Brooks Carthon, PhD,RN
PRINCIPAL_INVESTIGATOR
University of Pennsylvania

Study Locations (Sites)

Upenn School of Nursing Centre For Health Outcomes Policy Research
Philadelphia, Pennsylvania, 19104
United States

Collaborators and Investigators

Sponsor: University of Pennsylvania

  • Jacqueline M Brooks Carthon, PhD,RN, PRINCIPAL_INVESTIGATOR, University of Pennsylvania

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2024-04-15
Study Completion Date2026-10-01

Study Record Updates

Study Start Date2024-04-15
Study Completion Date2026-10-01

Terms related to this study

Additional Relevant MeSH Terms

  • Care Transitions