High Risk Outpatient Intern-led Care (HeROIC) Clinic Initiative

Not Applicable

Withdrawn

• Conditions: Risk Reduction; Emergencies; Comorbidities and Coexisting Conditions
• Interventions: Other: High Risk Clinic

• Registration Number: NCT04375189
• Lead Sponsor: Johns Hopkins University

Brief Summary

Background: A small subset of the patient population is responsible for a significant proportion of healthcare expenditures. These patients are cared for in academic medical centers by internal medicine residents however there has been no research to date about the education or the management of patients with complex multimorbidity in the outpatient setting.

Objective: To evaluate the impact of the High Risk Outpatient Intern-led Care (HeROIC) Clinic on internal medicine interns' perceived ability to manage complex outpatients as well as pre and post intervention total patient healthcare cost.

Methods: The investigators created the HeROIC outpatient clinic environment to comprise longer visit time slots, "bedside" presentations, and team-based care (one intern primary care provider, one secondary intern, and one longitudinal attending). All non-preliminary interns based at one primary care site participated in the intervention while interns at a second site continued to practice in the usual outpatient clinic environment. The interns in the HeROIC clinic arm assumed the roles of primary care providers for 34 complex patients in total. The primary outcome was the perceived confidence in the management of complex outpatients as assessed by a survey. Secondary outcomes included perceptions about the ability to provide high-quality outpatient and evidence-based outpatient care, as well as statewide pre-post patient healthcare cost data.

Detailed Description

Not available

Study Timeline

• Study Start: 2016-07-01
• Study First Submitted: 2020-05-01
• Study First Submitted QC: 2020-05-04
• Study First Posted: 2020-05-05
• Status Verified: 2022-07
• Primary Completion: 2022-07-01
• Study Completion: 2022-07-20
• Last Update Submitted: 2022-07-20
• Last Update Posted: 2022-07-25

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

• ≥ 6 medical comorbidities
• ≥ 2 admissions past 6 months or ≥ 4 past 1 year
• New or returning patient in resident primary care clinic

Exclusion Criteria

• Primary mental health disease driving hospitalizations

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Complex Clinic Arm	High Risk Clinic	-

Primary Outcome Measures

Name	Time	Method
Number of Inpatient or ER visits	Up to 2 years post enrollment	Presentations to the ER and hospitalizations

Secondary Outcome Measures

Name	Time	Method
Total medical cost	Up to 2 years post enrollment	Total medical costs (Outpatient, Inpatient, Imaging, Labs)

Trial Locations

Locations (1)

Johns Hopkins Outpatient Center; 🇺🇸 Baltimore, Maryland, United States