Implementation of a Primary Hospitalist Provider Team to Enhance the Care for High-Need High-Complexity Patients Requiring Hospitalization
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 1,200
- 试验地点
- 1
- 主要终点
- Number of patients readmitted to the PHP team
研究概览
简要总结
The goal of this pragmatic clinical trial is to learn if it is possible to implement a Primary Hospital Provider (PHP) team that aims to improve continuity of care for patients who are frequently hospitalized. The main question it aims to answer is: Are patients assigned to the PHP team more likely to be assigned to this team during a follow up hospitalization? Researchers will compare this to similar patients assigned to receive usual care. Some patient participants (or their caregivers) from both the PHP team and usual care groups will be asked to participate in interviews to help researchers understand the needs of patients who are frequently admitted and the care they receive.
详细描述
The overarching goal of this study is to reduce inpatient care fragmentation for high-need, high-complexity (HNHC) patients and improve outcomes by implementing a primary hospital provider (PHP) team. In this study, we will specifically evaluate the feasibility of implementation of this team as well as workforce and operational acceptance, as well as its impact on continuity of hospital medicine care across subsequent admissions.
The study is conducted as a two-arm, pragmatic hybrid type II effectiveness implementation trial with two sequential phases. Phase 1 focuses on initial feasibility and early acceptability of the PHP team. Phase 2 evaluates sustained implementation, reach, and longitudinal continuity outcomes using the same intervention, eligibility criteria, and study procedures. No changes will be made to the intervention, eligibility criteria, or data collection methods between phases.
Study Aims:
Aim 1 Primary Implementation Objective: Compare the fragmentation in hospital medicine care during subsequent admissions for HNHC patients assigned to the PHP team with those continuing to receive usual care.
- Aim 1a (Phase 1): Assess feasibility and early continuity of care during subsequent admissions.
- Aim 1b (Phase 2): Evaluate sustained continuity and re-exposure to the PHP team across repeated hospitalizations over an extended enrollment period.
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
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age greater than 18 at the time of index admission
- •Two or more hospitalizations to a general medicine service at UW Health (University Hospital or East Madison Hospital) within the past 12 months AND an EPIC Readmission Risk Score of greater than a predetermined value
排除标准
- •Outpatient primary care provider is part of the UW Health Family Medicine service that currently admits their own patients to a separate service at University Hospital
- •Patients with an oncologic diagnosis for which they are actively receiving chemotherapy or immunotherapy
- •Incarcerated persons
- •Pregnant women
研究组 & 干预措施
PHP Team
PHP Team
干预措施: Primary Hospital Provider Team (Other)
Usual Care
Usual Care hospital medicine team
结局指标
主要结局
Number of patients readmitted to the PHP team
时间窗: Implementation Phase 1 up to 9 months, Sustained Implementation Phase 2 up to 33 months
The number of patients in the PHP arm who were readmitted to the PHP team on subsequent hospitalizations.
Number of patients readmitted to usual care team
时间窗: Implementation Phase 1 up to 9 months, Sustained Implementation Phase 2 up to 33 months
The number of patients in the usual care arm who were readmitted to a usual care team on subsequent hospitalizations.
Percentage of patients readmitted to the PHP team
时间窗: Implementation Phase 1 up to 9 months, Sustained Implementation Phase 2 up to 33 months
The percentage of patients in the PHP arm who were readmitted to the PHP team on subsequent hospitalizations.
Percentage of patients readmitted to usual care team
时间窗: Implementation Phase 1 up to 9 months, Sustained Implementation Phase 2 up to 33 months
The percentage of patients in the usual care arm who were readmitted to a usual care team on subsequent hospitalizations.
次要结局
未报告次要终点