title: A randomized controlled trial of intensive care management for disabled Medicaid beneficiaries with high health care costs.
abstract: OBJECTIVE
  To evaluate outcomes of a registered nurse-led care management intervention for disabled Medicaid beneficiaries with high health care costs.
  
  
  METHODS
  Washington State Department of Social and Health Services Client Outcomes Database, 2008-2011.
  
  
  METHODS
  In a randomized controlled trial with intent-to-treat analysis, outcomes were compared for the intervention (n = 557) and control groups (n = 563). A quasi-experimental subanalysis compared outcomes for program participants (n = 251) and propensity score-matched controls (n = 251).
  
  
  METHODS
  Administrative data were linked to describe costs and use of health services, criminal activity, homelessness, and death.
  
  
  RESULTS
  In the intent-to-treat analysis, the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod. In the subanalysis, participants had fewer unplanned hospital admissions and lower associated costs; higher prescription drug costs; higher odds of long-term care service use; higher drug/alcohol treatment costs; and lower odds of homelessness.
  
  
  CONCLUSIONS
  We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management. Among participants, care management may have the potential to increase access to needed care, slow growth in the number and therefore cost of unplanned hospitalizations, and prevent homelessness. These findings apply to start-up care management programs targeted at high-cost, high-risk Medicaid populations.
authors.affiliation: Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817.
authors.forename: Janice F
authors.initials: JF
authors.lastname: Bell
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.|Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.|Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD.
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.|Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD.
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.|Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD.
authors.forename: David C
authors.initials: DC
authors.lastname: Atkins
authors.affiliation: Washington State Department of Social and Health Services, Research and Data Analysis Division, Olympia, WA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Court
authors.affiliation: Washington State Department of Social and Health Services, Research and Data Analysis Division, Olympia, WA.
authors.forename: David
authors.initials: D
authors.lastname: Mancuso
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.|Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD.
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D003415:Crime / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D014861:Washington
keywords: Chronic disease; access; care management; demand; disability; utilization of services