BackgroundChronically ill adults insured by Medicaid experience health inequities following hospitalisation.Local problemPostacute outcomes, including rates of 30-day readmissions and postacute emergency department (ED), were higher among Medicaid-insured individuals compared with commercially insured individuals and social needs were inconsistently addressed.MethodsAn interdisciplinary team introduced a clinical pathway called ‘THRIVE’ to provide postacute wrap-around services for individuals insured by Medicaid.InterventionEnrolment into the THRIVE clinical pathway occurred during hospitalisation and multidisciplinary services were deployed into homes within 48 hours of discharge to address clinical and social needs.ResultsCompared with those not enrolled in THRIVE (n=437), individuals who participated in the THRIVE clinical pathway (n=42) experienced fewer readmissions (14.3% vs 28.4%) and ED visits (14.3% vs 28.8 %).ConclusionTHRIVE is a promising clinical pathway that increases access to ambulatory care after discharge and may reduce readmissions and ED visits.
Background
Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people over age 65, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal post-hospital care continuum. The current study evaluates the implementation of THRIVE – an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge.
Methods
Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Trial
Discussion
The implementation and evaluation of the THRIVE clinical pathway will identify clinical supports and practice factors that influence success.
Trial Registration
ClinicalTrials.govNCT05714605. Registered February 6, 2023 – Implementation and Evaluation of a Health Innovation to Support Medicaid-Insured Individuals Following Hospitalization
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