Improving How People Living With Dementia Are Selected for Care Coordination: A Pragmatic Clinical Trial Embedded in an Accountable Care Organization
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 385
- 试验地点
- 2
- 主要终点
- Number of Emergency Department Visits or Hospital Admissions
研究概览
简要总结
Many people living with dementia (PLWD) and their care partners may benefit from the assistance of a care coordinator, a member of the medical team who facilitates communication among all the people involved. However, care coordinators' time is limited, and there is uncertainty about which patients should be selected to receive their help. This pragmatic clinical trial embedded in an accountable care organization will determine the comparative effectiveness of two approaches for assigning care coordinators to PLWD.
详细描述
This project will use a pragmatic clinical trial embedded in an accountable care organization (ACO) to determine the comparative effectiveness of two different approaches for selecting PLWD to receive support from care coordinators: (1) an approach that assigns PLWD to care coordinators based on care partners' self-reported difficulty with care coordination, or (2) usual care, which generally assigns PLWD to care coordinators after hospital discharge, regardless of perceived need. The investigators will include community-dwelling Medicare beneficiaries ≥65 years old with dementia who have been attributed to the NewYork Quality Care ACO and who have fragmented care. The investigators will randomize the participants into two groups. This study is highly pragmatic, and the intervention is sustainable and scalable. Moreover, the proposed approach has the potential to improve care delivery and outcomes for PLWD.
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
- •Medicare beneficiaries ≥65 years old who:
- •Are attributed to the NewYork Quality Care accountable care organization by Medicare,
- •Have dementia (as measured in claims using the Bynum standard 1-year definition),
- •Reside in the community, and
- •Had fragmented ambulatory care in the previous 12 months (defined as a reversed Bice-Boxerman Index greater than or equal to the median score for this population, using Medicare claims)
排除标准
- •Those who reside in long-term care or nursing home facilities (based on addresses in Medicare claims), or
- •Enrolled in home hospice
结局指标
主要结局
Number of Emergency Department Visits or Hospital Admissions
时间窗: Over 12 months (beginning 1 month after the start of care coordination)
Occurrence of an emergency department visit or hospital admission, as measured in Medicare claims
次要结局
- Acceptability(Up to 1 year)
- Appropriateness(Up to 1 year)
- Fidelity(Up to 1 year)
- Efficiency(Up to 1 year)