Limitations
Our study has several limitations. The Camden Core Model did not establish a priori criteria to define full intervention exposure at the time of trial implementation. We used a combination of data distributions and guidance from program designers to select the engagement definition used for this analysis and tested several variations in sensitivity analyses. Although our study provided insight into the characteristics of patients who were less likely to be engaged, we were unable to assess causes of variable intervention exposure. Our results should not be interpreted to suggest that unengaged patients would have achieved outcomes comparable with engaged patients had they received a more complete intervention dose.We analyzed readmissions at 180 days as the primary outcome for consistency with the original evaluation. However, the focus on this singular outcome measure as the primary value mechanism for complex care may distract from a broader range of potential benefits. While there are patients for whom reducing hospitalizations is an appropriate goal of complex care management, for others, frequent hospitalizations result from exceptional circumstances that are not resolved irrespective of intensive intervention.