Using Social Workers to Manage Inpatient Care Transitions: Evidence from a Randomized Experiment

CCWVa has partnered with three West Virginia hospitals to launch the Hospital Transition Program (HTP). The goal of the program is to provide support and training for continued care after a patient is discharged from the hospital. Under the HTP, a case manager meets with eligible patients in the hospital and at their home after discharge, assessing needs based on conversations with the patient and an evaluation of their home environment while also coordinating services with local agencies to ensure that patients are in the best possible position to carry out their care plan for recovery.

2023-07-01

2025-07-01

The study’s primary object is to estimate the impact of the HTP on 30-, 60-, and 90-day hospital readmission rates and the costs of readmissions.

The study’s secondary objective is to examine how effects vary by patient acuity and insurance status.

The Hospital Transition Program targets patients in three West Virginia hospitals that have been identified as having a high probability of hospital readmission. The three hospitals include: Wheeling Hospital (Wheeling, WV), Cabell-Huntington Hospital (Huntington, WV ), and St. Mary’s Hospital (Huntington, WV).

Eligible patients must meet the following criteria:
- Adults aged 18 and above
- Currently admitted at Wheeling, Cabell-Huntington, or St. Mary’s Hospital
- Covered by Medicare or Medicaid (including dual eligibles)
- Resides in a ZIP code within 15 miles of the admitting hospital.
- Readmission risk score (probability) at time of admission in top quartile within hospital. A patient’s readmission risk score is a probability of readmission based on a patient’s initial diagnosis, comorbidities, previous hospital admissions, and social determinants of health.

Patients will be excluded if they meet any of the following criteria:
- Already a subject in the RCT (treatment or control)
- Deceased or discharged prior to triage or recruitment
- Discharged to a long-term care facility
- Homeless
- Index hospitalization is for a child birth

Each afternoon, the participating hospitals’ management information systems will flag any newly-admitted patients that meet the eligibility criteria established above. Patients will be ordered sequentially based on their admission to the hospital; for each two new patients that are added, one will be randomly assigned to a CCWVa case manager who will then contact the patient in the hospital, outline the services offered by the HTP, and if they agree, consent the patient to receive services.

Computer random number generator

Individual

No

N/A/

4,800

We expect that 2400 patients will be eligible across the three hospitals each year. Given an even chance of being offered services, 1200 patients will be offered services. We conservatively assume a 50 percent consent rate. Even if the 70 percent consent rate as reported by the current case manager materializes, this will still be within the outer bounds of what the case managers can handle. If the consent rate is higher than 70 percent, we will adjust the probability of enrollment into treatment. We plan to enroll into the study for two years.

Over a two-year period, we anticipate enrolling 4,800 individuals in the experiment, with half being assigned to the treatment group and an expected take-up rate of 50%. Based on data provided by the hospitals about their readmission rates for the eligible population, we expect the baseline readmission rate for the sample to be 22%. With power of 0.80 and an alpha of 0.05, we will be able to detect a 3.2 percentage point decline in an intention to treat, which implies a 6.4 percentage point decline in the treatment on the treated model. These projections are in line with the estimates found in Evans et al. (2021) in their evaluation of the transition program run by Catholic Charities Chicago.

CCWVa Preanalysis Plan