Evaluation of Intensive Management Patient Aligned Care Team

NCT02932228 | Completed Results

• 1 other identifier: PPO 13-117
• Study Type: interventional
• Target: 583
• Locations: 0 countries
• Sites: N/A

Brief Summary

This evaluation will examine the feasibility, implementation, and effectiveness of a quality improvement intervention-Intensive Management Patient Aligned Care Team (ImPACT)-for high-risk patients.

Conditions

Primary Health Care; Health Care Costs

Outcome Measures

Primary Outcomes (1)

• VA Health Care Costs

  Estimated programs effect on cost among all patients, and correspond to the change in monthly costs among patients in impact minus the change in costs for patients in PACT.

  17 months

Secondary Outcomes (3)

• Hospitalization

  17 months

• Emergency Department Utilization

  17 months

• Outpatient Utilization

  17 months

Other Outcomes (7)

• Feasibility: Time to Enrollment

  9 months

• Feasibility: Participation

  9 months

• Implementation Process

  9 months

Study Arms (2)

ImPACT

EXPERIMENTAL

Patients in ImPACT receive intensive outpatient care from the ImPACT team. The ImPACT team augments existing PACT primary care with intensive services delivered by a multidisciplinary team (including a physician, nurse practitioner, social worker, recreational therapist, and program coordinator). ImPACT program elements include a comprehensive patient assessment, identification and tracking of patients' goals and priorities, care management for medical and social service needs, co-attendance at specialty care appointments, and coordination of care with VA and non-VA providers, including during and after hospitalization.

Other: ImPACT

PACT

NO INTERVENTION

Patients in PACT receive usual VA primary care through the VA's Patient Centered Medical Home. VA primary care is delivered by PACT teamlets that comprise a primary care provider, nurse, clinical associate, and administrative associate who are supported by social work, pharmacy, and behavioral health services.

Interventions

ImPACT OTHER

The ImPACT team offers the following services: * An intensive intake process, including a home visit if deemed appropriate * Frequent contact (in-person, telephone, or secure messaging) tailored to a patient's needs * After-hours access to on-call team member in order to avoid unnecessary emergency care * Optimization of chronic condition management using evidence-based protocols * Navigation of transitions between hospital and home * Coordination of specialty care, including contact with specialists when indicated * Rapid response to signs of health status deterioration or other stressful events * Assess patient goals, advance directives, Physician Orders for Life-Sustaining Treatment

ImPACT

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient receives care from one of 14 primary care providers (MDs, NPs) who have at least three half-days of clinic per week
• Total VA healthcare costs in the top 5% for VA Palo Alto facility during the 9-month eligibility phase (10/1/11-6/30/12) AND/OR
• Risk for one-year hospitalization in November 2012 in the top 5% (using the VA's Care Assessment Need risk-prediction algorithm)

You may not qualify if:

• Enrollment in VA's mental health intensive case management program, home-based primary care, or palliative care programs
• Recipient of inpatient care for over half of the 9-month eligibility phase (10/1/11-6/30/12).
• Total VA healthcare costs in the lowest cost decile in the 9-month eligibility phase (10/1/11-6/30/12)
• Risk for one-year hospitalization in November 2012 in the lowest risk quartile (using the VA's Care Assessment Need risk-prediction algorithm).

Sponsors & Collaborators

• VA Office of Research and Development: lead
• VA Palo Alto Health Care System: collaborator
• Veteran Affairs Office of Patient Care Services: collaborator

Related Publications (11)

• Zulman DM, Jenchura EC, Cohen DM, Lewis ET, Houston TK, Asch SM. How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions. J Gen Intern Med. 2015 Aug;30(8):1063-70. doi: 10.1007/s11606-015-3222-9. Epub 2015 Feb 18.

  PMID: 25691239 BACKGROUND

• Zulman DM, Pal Chee C, Wagner TH, Yoon J, Cohen DM, Holmes TH, Ritchie C, Asch SM. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System. BMJ Open. 2015 Apr 16;5(4):e007771. doi: 10.1136/bmjopen-2015-007771.

  PMID: 25882486 BACKGROUND

• Gidwani R, Zulman D. Association Between Acute Medical Exacerbations and Consuming or Producing Web-Based Health Information: Analysis From Pew Survey Data. J Med Internet Res. 2015 Jun 23;17(6):e145. doi: 10.2196/jmir.3801.

  PMID: 26104000 BACKGROUND

• Breland JY, Greenbaum MA, Zulman DM, Rosen CS. The effect of medical comorbidities on male and female Veterans' use of psychotherapy for PTSD. Med Care. 2015 Apr;53(4 Suppl 1):S120-7. doi: 10.1097/MLR.0000000000000284.

  PMID: 25767965 BACKGROUND

• Hunter G, Yoon J, Blonigen DM, Asch SM, Zulman DM. Health Care Utilization Patterns Among High-Cost VA Patients With Mental Health Conditions. Psychiatr Serv. 2015 Sep;66(9):952-8. doi: 10.1176/appi.ps.201400286. Epub 2015 May 1.

  PMID: 25930040 BACKGROUND

• Breland JY, Chee CP, Zulman DM. Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans. J Racial Ethn Health Disparities. 2015 Jun;2(2):167-75. doi: 10.1007/s40615-014-0060-0. Epub 2014 Nov 8.

  PMID: 26863335 BACKGROUND

• Hummel DL, Hill C, Shaw JG, Slightam C, Zulman DM. Nurse practitioner-led intensive outpatient team: Effects on end-of-life care. The Journal for Nurse Practitioners. 2017 Mar 14; 13(5):e245-e248

  BACKGROUND

• Zulman DM, Ezeji-Okoye SC, Shaw JG, Hummel DL, Holloway KS, Smither SF, Breland JY, Chardos JF, Kirsh S, Kahn JS, Asch SM. Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT). J Gen Intern Med. 2014 Dec;29 Suppl 4(Suppl 4):861-9. doi: 10.1007/s11606-014-3022-7.

  PMID: 25355084 RESULT

• Breland JY, Asch SM, Slightam C, Wong A, Zulman DM. Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis. Healthc (Amst). 2016 Mar;4(1):22-9. doi: 10.1016/j.hjdsi.2015.12.005. Epub 2015 Dec 29.

  PMID: 27001095 RESULT

• Zulman DM, Pal Chee C, Ezeji-Okoye SC, Shaw JG, Holmes TH, Kahn JS, Asch SM. Effect of an Intensive Outpatient Program to Augment Primary Care for High-Need Veterans Affairs Patients: A Randomized Clinical Trial. JAMA Intern Med. 2017 Feb 1;177(2):166-175. doi: 10.1001/jamainternmed.2016.8021.

  PMID: 28027338 RESULT

• Wu FM, Slightam CA, Wong AC, Asch SM, Zulman DM. Intensive Outpatient Program Effects on High-need Patients' Access, Continuity, Coordination, and Engagement. Med Care. 2018 Jan;56(1):19-24. doi: 10.1097/MLR.0000000000000833.

  PMID: 29087980 RESULT

Results Point of Contact

• Title: Dr Donna Zulman
• Organization: VA Palo Alto Health Care System

Donna.Zulman@va.gov

650-493-5000

Study Officials

• Donna M Zulman, MD MS

  VA Palo Alto Health Care System, Palo Alto, CA

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 6, 2016
• First Posted: October 13, 2016
• Study Start: January 1, 2013
• Primary Completion: June 1, 2014
• Study Completion: May 1, 2015
• Last Updated: June 12, 2019
• Results First Posted: May 29, 2019

Record last verified: 2019-05

Data Sharing

• IPD Sharing: Will not share