Improving How Older Adults at Risk for Cardiovascular Outcomes Are Selected for Care Coordination
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 400
- 试验地点
- 1
- 主要终点
- Number of Emergency Department Visits or Hospital Admissions
研究概览
简要总结
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.
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 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.
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 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)
排除标准
- •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)
研究组 & 干预措施
Intervention
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.
干预措施: Care coordination delivered based on perceived need (Behavioral)
Control
Usual care assigns patients to care coordinators in response to a discharge from a hospital or a direct referral from a physician.
干预措施: Care coordination delivered based on usual care (e.g. discharge from hospital) (Behavioral)
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. This outcome measure allows more than one event per participant.
次要结局
- Acceptability(Up to 1 year of follow-up)
- Appropriateness(Up to 1 year of follow-up)
- Fidelity(Up to 1 year of follow-up)
- Efficiency(Up to 1 year of follow-up)