Improving care transitions for Medicaid patients with serious mental illness

An Equity-focused Intervention to Improve Care Transitions for Medicaid Insured Individuals With Co-occurring Chronic Medical Conditions and Serious Mental Illness

NA · University of Pennsylvania · NCT06203509

This study is testing a new care program for people with serious mental illness on Medicaid to see if providing home care right after they leave the hospital helps them stay healthy and avoid going back to the hospital.

Quick facts

PhaseNA
Study typeInterventional
Enrollment267 (estimated)
Ages18 Years and up
SexAll
SponsorUniversity of Pennsylvania (other)
Locations1 site (Philadelphia, Pennsylvania)
Trial IDNCT06203509 on ClinicalTrials.gov

What this trial studies

This study evaluates the THRIVE clinical pathway at HUP-Cedar, focusing on Medicaid-insured individuals with serious mental illness after hospitalization. It employs a mixed methods approach, combining qualitative and quantitative data to assess the feasibility and effectiveness of the intervention. The study will analyze referral patterns, readmission rates, and emergency department utilization, while also exploring healthcare providers' perspectives on the implementation process. Participants will receive home care services shortly after discharge, with oversight from healthcare providers for 30 days.

Who should consider this trial

Good fit: Ideal candidates are Medicaid-insured individuals residing in Pennsylvania who have been hospitalized and agree to home care services.

Not a fit: Patients under the age of 18 will not benefit from this study.

Why it matters

Potential benefit: If successful, this study could enhance care transitions and reduce readmission rates for Medicaid patients with serious mental illness.

How similar studies have performed: Other studies have shown success with similar interventions aimed at improving care transitions for patients with complex needs.

Eligibility criteria

Show full inclusion / exclusion criteria
Inclusion Criteria:

* Medicaid insured
* Residing in the state of Pennsylvania
* Experienced a hospitalization at study hospital
* Agrees to home care at partner home care setting.

Exclusion Criteria:

* Individuals under age 18

Where this trial is running

Philadelphia, Pennsylvania

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.

View on ClinicalTrials.gov →

Conditions: Care Transitions

Last reviewed 2026-05-15 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.