This study tests a strategy for helping Care Management Agencies prioritize patients with HIV (PWH) for outreach and support. Under the new strategy, care managers are given a list of highest-priority patients who have been identified by a computer algorithm as being at high risk of going to the emergency room in the next two weeks. This strategy is compared to traditional (standard of care) care management, in which care managers reach out to patients based on a set schedule and their clinical judgement (but not based on a computerized report). We are looking at whether the use of the computer report helps care managers reach the right patients at the right time, preventing them from having to go to the emergency room.
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
ER visits
Timeframe: Each 18 month cluster period (36 months total)
Hospitalizations
Timeframe: Each 18 month Cluster Period (36 months total)
Viral Suppression
Timeframe: Each 18 month cluster period (36 months total)
CD4 Count
Timeframe: Each 18 month Cluster Period (36 months total)