Health TrialsbyHealthPanel

Addressing Social Needs to Improve Health in Adults With Multiple Chronic Conditions

ConditionsMultiple Chronic ConditionsSocial NeedsCare GapsNavigation
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorKaiser Permanente

About this trial

The investigators will conduct a comparative effectiveness randomized clinical trial with two "active comparator" arms. The investigators will evaluate the two current, usual care strategies (higher intensity "telephonic navigation" vs. lower intensity "virtual outreach") for addressing social needs among patients with multiple chronic conditions.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Two or more chronic medical conditions from a defined list of 24 chronic conditions

One or more gaps in evidence-based care (related to condition-specific risk factor management, evidence-based screening and preventive care, missed appointments, and medication non-adherence),

At least one self-reported social-related barrier to care or "social need" (e.g., transportation, food, housing, utilities, and/or financial insecurity).

Disqualifiers

major cognitive barriers (dementia, psychosis).

multiple prior year hospitalizations ("extremely high utilizers")

Trial design

Design model

Parallel

Treatments tested in this trial

  • Telephonic Outreach

    Behavioral

    Higher Intensity (active telephonic outreach from a health navigator with follow-up contacts for up to 3 months)

  • Virtual Outreach

    Behavioral

    Lower Intensity (outreach via text, email, and/or letter with materials that contain information about available local, state, and federal governmental benefits and services)

Treatment groups

800 Participants
are divided into 2 treatment groups
Group A: Telephonic NavigationExperimental treatment 1 intervention
Group B: Virtual OutreachActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Receipt of social services

Patient survey re: receipt of resources from available programs

Time frame
approximately 6 months after enrollment
2

Reduction in number of social needs

Reduction from baseline in number of unmet social needs

Time frame
approximately 6 months after enrollment
3

Clinical care gap closure

Reduction in number of evidence-based clinical care gaps

Time frame
approximately 12 months after enrollment

Secondary outcomes

Other outcomes

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Kaiser Permanente

Lead sponsor

Source ClinicalTrials.gov
Apply now