Video-Enhanced Care Management for Medically Complex Veterans
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 80
- 试验地点
- 2
- 主要终点
- Number of Participants Reporting That They Would Be Likely to See a Healthcare Provider Using Videochat
研究概览
简要总结
The purpose of this study is to examine the feasibility and acceptability of a 12-week care management program for medically complex Veterans with cognitive impairment, delivered via telephone or videoconferencing.
详细描述
BACKGROUND Older adults with complex care needs constitute a large and rapidly expanding group of Veterans receiving care within Veterans Health Administration (VHA). Medically complex older Veterans, who often have multiple chronic conditions (MCC) as well as interacting functional and psychosocial challenges, account for a disproportionate amount of health care resources. Importantly, these Veterans also experience a disproportionate amount of suffering; they have worse functional status, higher symptom burden, and spend more of their time in acute care settings such as the hospital and emergency department.
The investigators' experience and recent studies suggest that a substantial proportion of older medically complex Veterans have unrecognized cognitive impairment (CI), and this contributes to their disproportionate need for care and adverse outcomes. The Cumulative Complexity model posits that complexity results from accumulating and interacting clinical and social factors that each contribute to a patient's workload (e.g. making appointments and managing complicated medicine regimens) as well as impact a patient's capacity to perform everyday tasks including those related to health care. Imbalance between the two- i.e. workload that exceeds capacity-is a primary driver of disruptions in care and negative outcomes. Older patients with MCC, high health care utilization, and CI often find themselves in the perfect storm of complexity, simultaneously experiencing escalated workload demands in the setting of reduced capacity.
OBJECTIVES
The primary objectives of this pilot study are to:
Examine the feasibility and acceptability of a 12-week care management program for medically complex Veterans with CI, delivered via telephone or through video visits.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Receive primary care from a Durham Veterans Affairs Medical Center (VAMC) affiliated primary care clinic (1 visit within the previous 12 months)
- •Age > or = 65
- •CAN score > or = 90
- •Valid telephone number in the medical record
- •Identifies a friend or family member that we may contact for study participation as the Care Partner
- •Telephone Instrument for Cognitive Status - modified (TICS-m) score 20-31
排除标准
- •Cognitive impairment or dementia (identified via ICD diagnosis codes or Primary Care Provider note in previous 2 years)
- •Enrolled in or have an active consult for a special population Patient Aligned Care Teams (PACT), e.g.:
- •Home Based Primary Care
- •Mental Health
- •Post-Deployment, etc.
- •Serious mental illness defined as diagnosis of psychosis of any type:
- •schizophrenia
- •bipolar disorder
- •psychiatric hospitalization in the previous year
- •or current high-risk suicide flag in their Computerized Patient Record System (CPRS) medical record
- •Active substance abuse, documented in the medical record within the previous year
- •Eligible for hospice, palliative care, or prognosis of less than 6 months to live
- •Lacks decision-making capacity, documented in the medical record
- •Referred to institutional care or residing in nursing home
- •Unable to communicate on the telephone, or no telephone access for duration of study
- •Currently hospitalized or incapacitated
- •Enrolled in a study that prohibits participation in another study
研究组 & 干预措施
Videoconference care management
12-week nurse care management for medically complex Veterans with CI delivered via videoconferencing
干预措施: Care management via videoconference (Behavioral)
Telephone care management
12-week nurse care management for medically complex Veterans with CI delivered via telephone calls
干预措施: Care management via telephone calls (Behavioral)
结局指标
主要结局
Number of Participants Reporting That They Would Be Likely to See a Healthcare Provider Using Videochat
时间窗: 14 weeks
Acceptability will be assessed using the measure of likelihood of seeing a healthcare provider using videochat.
Number of Scheduled Intervention Phone or Video Calls Completed by Participants
时间窗: 14 weeks
Feasibility will be assessed by examining rates of adherence to intervention phone/video calls.
Usability of Video-Enhanced Care Management for Medically Complex Veterans With CI
时间窗: 14 weeks
Usability of the video-enhanced care management program will be examined using the System Usability Scale (SUS; range 0 - 100; higher scores are better).
次要结局
未报告次要终点