Improving How Older Adults at Risk for Cardiovascular Outcomes Are Selected for Care Coordination
- Conditions
- Myocardial InfarctionTransient Ischemic AttackCardiovascular DiseasesAtrial FibrillationHeart FailureHyperlipidemiasHypertensionIschemic Heart DiseaseStrokeDiabetes Mellitus
- Interventions
- Behavioral: Care coordination delivered based on perceived needBehavioral: Care coordination delivered based on usual care (e.g. discharge from hospital)
- Registration Number
- NCT05820295
- Lead Sponsor
- Weill Medical College of Cornell University
- Brief Summary
This pragmatic clinical trial embedded in an accountable care organization will determine the comparative effectiveness of two approaches for assigning care coordinators to older adults at risk for cardiovascular outcomes. The hypothesis is that assigning care coordinators to older adults based on perceived need will be more effective at preventing emergency department visits and hospitalizations compared to usual care.
- Detailed Description
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 older adults at risk for cardiovascular outcomes to receive support from care coordinators: (1) an approach that assigns older adults to care coordinators based on self-reported difficulty with care coordination, or (2) usual care, which generally assigns older adults to care coordinators after hospital discharge, regardless of perceived need. The investigators will include community-dwelling Medicare beneficiaries ≥65 years old with cardiovascular disease (CVD) or 1 or more CVD risk factors 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 older adults at risk for cardiovascular outcomes.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 400
- Medicare beneficiaries 65 years and older,
- Attributed to the NewYork Quality Care accountable care organization,
- Are community-dwelling,
- Have cardiovascular disease or 1 or more cardiovascular risk factors, and
- Had highly fragmented ambulatory care in the prior year (defined as a reversed Bice-Boxerman Index greater than or equal to 0.85)
- Those who reside in long-term care or nursing home facilities (based on addresses in Medicare claims)
- Enrolled in home hospice
- Dementia (as measured in claims using the Bynum Standard 1-year definition)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention Care coordination delivered based on perceived need The intervention group will assign care coordinators to individuals based on perceived need for assistance with care coordination. Perceived need will be measured through a proxy's responses to a previously validated telephone survey on perceptions of care coordination. Control Care coordination delivered based on usual care (e.g. discharge from hospital) Usual care assigns patients to care coordinators in response to a discharge from a hospital or a direct referral from a physician.
- Primary Outcome Measures
Name Time Method Number of emergency department visits or hospital admissions 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
- Secondary Outcome Measures
Name Time Method Acceptability, as measured by change in the number of self-reported problems with care coordination Baseline; 1 month Change in the number of self-reported problems with care coordination at 1 month after the start of care coordination compared to baseline
Fidelity, as measured by the percent of eligible individuals who receive care coordination services Up to 1 year The percent of eligible individuals who receive care coordination services
Appropriateness, as measured by the number of care coordination activities in each group, listed by type Up to 1 year The number of care coordination activities in each group (e.g., facilitating provider-provider communication, arranging transportation, etc.)
Efficiency, as measured by the total number of care-coordinator hours used Up to 1 year The total number of care-coordinator hours used in each study group
Trial Locations
- Locations (1)
New York Presbyterian Hospital - Weill Cornell Medicine
🇺🇸New York, New York, United States