Equity Centered Post Discharge Support for Medicaid Insured:  A Type 1 Hybrid Effectiveness Implementation Stepped-Wedge Cluster Randomized Trial Study Protocol For The ‘THRIVE’ Clinical Pathway

Abstract

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