Comparing Two Approaches to Care Coordination for High-Cost/High-Need Patients in Primary Care
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 25,507
- 试验地点
- 3
- 主要终点
- Change in Composite Measure of Care Quality
研究概览
简要总结
Medical care has improved greatly over the past 50 years. Treatments for most medical conditions can help us lead longer and healthier lives, but there are still problems. Many patients with two or more conditions see many different doctors and sometimes take more medications than needed. These patients can feel lost and confused. In addition, non-medical issues involving housing, food, transportation, employment, income, support from others, and language barriers can have a large impact on our health.
In Minnesota, many primary care clinics are using a method called care coordination to improve the health of patients who have a number of chronic diseases (some examples of chronic diseases include diabetes, heart disease, asthma and depression). With care coordination, a nurse in the clinic helps the various doctors, clinics, and specialists to work together, in the interest of the patient. In some clinics, a social worker also helps with care coordination. These social workers help with issues like housing, transportation, or employment. Care coordination can help reduce patient confusion. It also can improve health and lower patient burdens and costs of getting medical care.
To help find out what types of care coordination are most successful, we are proposing a study. Our plan is to track the health of patients receiving care coordination and compare two types:
A. Care coordination done by a nurse or other clinic staff B. Care coordination where a licensed social worker also assists the patient
In this study, we will measure many things, including:
- Control of chronic conditions like diabetes, heart disease, asthma, and depression
- Hospitalizations
- Emergency department visits
- Use of medications and diagnostic tests
- Use of specialty care
- General health status
- Patient satisfaction and access to care
- Use of shared decision-making (where the doctor and the patient make treatment decisions together)
- Patient burden (how much time and effort the patient spends trying to get healthy)
- Patients' out-of-pocket medical costs
This project will be important to patients because it could reduce confusion and fragmented care while improving all the items above. Those improvements will be more likely because this project takes advantage of engagement with patients and others. We have four patient partners who will help conduct the study and interpret and broadly share the results. The project was developed with the input from patients, clinic leaders, people from state government, and experts on health and quality care.
By measuring a wide variety of outcomes for the adults receiving coordination services in these clinics, we hope to identify the specific actionable information that will allow these and other clinics to improve their services for these patients with complex needs.
Throughout the project, we will communicate our findings to clinics and health systems. As a result, many people may receive better care.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
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 18 or older
- •Historical Cohort: Receiving care coordination services in a participating clinic with a care coordination start date between January 2018 and February 2019
- •Primary Cohort: Receiving care coordination services in a participating clinic with a care coordination start date between January 2021 and December 2021
- •Currently insured by the MN Department of Human Services (DHS), Blue Cross Blue Shield MN (BCBS), UCare, or HealthPartners (HP) (for utilization outcomes only)
- •Consents to participate in interview or responds to a survey (for those data collection events only)
排除标准
- •Cannot complete an interview in English (interviews only)
- •Cannot complete a survey in English, Spanish, Somali, or Hmong (for interviews only, reflecting most prevalent languages in MN)
- •On a known research exclusion list
结局指标
主要结局
Change in Composite Measure of Care Quality
时间窗: 12 months pre- and post- initiation of care coordination
The analytic outcome is defined as the absolute change in the percentage of eligible care quality measures met by a patient in the year before and after care coordination initiation. The composite measure of care quality is calculated as the percentage of all applicable care quality measures a patient meets based on clinical guidelines, including control of blood pressure, cardiovascular disease, diabetes, asthma, depression, and cancer screening. Criteria for each of the components was assessed using health outcomes from EHR and insurance claims to capture occurrence and timing of recommended screenings. A positive change (post % - pre % \> 0) reflects an improvement in the percentage of care quality measures met, while a negative change indicates a decline.
Change in Annual Number of Emergency Department Visits
时间窗: 12 months pre and post start of care coordination
Change in # of encounters with CPT-4 E\&M codes (99281-99288) at emergency departments across the year before and year after care coordination initiation per 100 people. Negative values of change represent improvement, positive values represent a increase in number of admissions.
Change in Annual Number of Inpatient Hospitalizations
时间窗: 12 months pre and post start of care coordination
Change in # of hospital inpatient admissions ≥ 1 days across the year before and year after care coordination initiation per 100 people. Negative values of change represent improvement, positive values represent a increase in number of admissions.
General Health Status - Top Box Scoring
时间窗: 6 to 18 months after start of care coordination
Percentage of patients reporting Excellent, Very Good, or Good when asked to rate general health status on 5-level Likert Scale (NHIS)
Rating of Primary Care Clinic - Top Box
时间窗: 6 to 18 months after start of care coordination
Percentage of patients reporting 9 or 10 when asked to rate primary care clinic (CG-CAHPS)
次要结局
- Change in Percent of Patients Meeting Chlamydia Screening (Up-to-date)(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Asthma Care at Goal(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Breast Cancer Screening Criteria(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Colorectal Cancer Screening (Up-to-date)(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Depression Screening Criteria(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting A1c Control(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Aspirin or Anti-Platelet Use Recommendations(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Blood Pressure Control Criteria(12 months pre and post start of care coordination)
- Change in Percent of Patients Meeting Statin Use Recommendations(12 months pre and post start of care coordination)
- Change in Percent of Patients Reporting Current Tobacco Use(12 months pre and post start of care coordination)
- Access to Care(6 to 18 months after start of care coordination)
- Rating of Care Coordinator(6 to 18 months after start of care coordination)
- Shared Decision Making(6 to 18 months after start of care coordination)
- Perceived Care Integration(6 to 18 months after start of care coordination)
- Going Without Care Due to Cost(6 to 18 months after start of care coordination)
- Out-of-pocket Medical Costs(6 to 18 months after start of care coordination)
- Medication and Care Burden(6 to 18 months after start of care coordination)
- Social Needs - Housing Security(6 to 18 months after start of care coordination)
- Social Needs - Food Security(6 to 18 months after start of care coordination)
- Social Needs - Access to Dependable Transportation(6 to 18 months after start of care coordination)
- Insurance Coverage(6 to 18 months after start of care coordination)