RESEARCH WEEKLY: When Negative Results in a Research Study Means Something More
Big news in the research world last month was the publication of the results from a randomized control trial on a care coordination model for people with complex care needs in Camden, New Jersey.
The Camden Coalition of Healthcare Providers has frequently appeared in our research reports and blogs. Their cross-sector data and analysis work on super-utilizers was highlighted in our 2017 report, A Crisis in Search of Data, due to their innovative use of integrating data from health, criminal justice and social service systems. In our 2019 report, Road Runners, we highlighted how the Camden Coalition uses data to divert people from the criminal justice system with a data analysis method called ‘hot-spotting.’
Results from a randomized control trial of the Camden Core Model published last month found that the model had no effect on improving the outcomes studied. However, a deeper look into the research methods and results shows that there is more meaning to the results besides the no-difference findings.
A deeper look
The Camden Core Model is a care management program that includes an interprofessional team of health providers who identify and enroll patients into the program before discharge from a hospital. Individuals are chosen based on the complexity of their needs, including those with severe mental illness. The team works with the patients to develop comprehensive discharge plans and meets with them regularly once in the community to reconcile medications, attend doctors’ appointments and help navigate the complex social service systems such as disability payments or housing. The model is designed to increase self-efficacy among participants in their own health and well-being and focuses on both the health services provided as well as social determinants of health, such as housing or food access.
Researchers randomly assigned 800 participants to either the Camden Core Model or treatment as usual. The primary outcome they used to identify success in the program was whether an individual was re-hospitalized within 180 days of discharge. Although they found that participants in the program had increased enrollment in food access programs and engagement in primary care services, there was no difference between the two groups on hospital readmission rates.
Despite these negative findings, leaders at the Camden Coalition argue that there was valuable information gained from the research study. The care coordination provided by their model can only be effective if the resources in the community to address complex needs of patients are adequate.
“Our teams struggled to find community-based services that could meet the needs of patients with high rates of mental health diagnoses, addiction, homelessness, and incarceration,” Kathleen Noonan CEO of the Camden Coalition of Healthcare Providers writes in a Health Affairs article. “Improvement in outcomes therefore stalled because primary care, behavioral health, addiction treatment, and housing services weren’t built to provide services to people with such extreme experiences and needs. What’s more, the systems themselves weren’t built for collaboration.”
As we found in A Crisis in Search of Data, individuals with severe mental illness are often an unaddressed population of those who are deemed super-utilizers. Care management programs aiming to reduce healthcare costs and improve outcomes must intentionally include treatment services for individuals with severe mental illness.
