Thrive Trial Shows Increase in Home Health Referrals for Medicaid Patients

Key Takeaways

• Trained discharge planners were more likely to refer eligible patients to home health services than planners who had not yet entered the intervention.
• Implementation ratings were uniformly high, with acceptability, appropriateness, and feasibility all viewed favorably by surveyed planners.
• Higher referral odds were reported in adjusted analyses for older patients, Black patients or patients from other non-White racial backgrounds, dually insured patients, and patients with more chronic conditions.

Among Medicaid-insured and dually eligible adults leaving medicine services for home, the stepped-wedge cluster-randomized Thrive Trial found a higher predicted chance of home health referral when discharge planners had been trained, at 27.6% versus 17.3%.

The 24-month type 1 hybrid effectiveness-implementation stepped-wedge cluster-randomized trial took place at a single hospital in the northeastern United States. Fourteen discharge planners on medicine services participated, including nurse case managers and social workers, and all chose to participate in referring to Thrive. The trial focused on Medicaid-insured and dually eligible adults discharged to home who would accept Penn Medicine At Home services. The intervention combined initial training on identifying eligible patients and making referrals, bi-weekly reminders during rollout, and monthly clinical updates once all planners were engaged.

The primary outcome was referral to home health services within 30 days of discharge, extracted from the electronic health record. In adjusted analyses, Thrive training was associated with higher referral odds, with an adjusted odds ratio of 1.98, a 95% confidence interval of 1.32 to 2.98, and a p value of 0.001. A 12-item validated instrument measured acceptability, appropriateness, and feasibility using 5-point Likert scoring. Mean scores were 4.9 out of 5 across all three domains, and in-person training plus manager reminders were rated most helpful. Of 14 planners, 12 completed the survey, 67% integrated the Thrive flag into their EHR workflow, and all surveyed planners endorsed the importance of continuing Thrive at their hospital. These findings indicated that the workflow supports were broadly workable from the planners’ perspective.

Adjusted odds of referral were also higher among older patients, Black patients or patients from other non-White racial backgrounds, dually insured patients, and patients with more chronic conditions. As an operational detail, 74.4% of 774 patients who received a home health referral received services through Penn Medicine At Home.

The authors also noted that the single-site academic medical center and shared workspace limited generalizability and allocation concealment, and that possible contamination remained a concern despite the stepped-wedge design.