Estonia's Enhanced Care Management Impact Evaluation

NCT05829642 | Completed

• 1 other identifier: P169891
• Study Type: observational
• Target: 2,389
• Locations: 1 country
• Sites: 1

Brief Summary

Estonia's aging population faces an increasing burden of non-communicable diseases (NCDs) and a growing population suffers with multiple chronic conditions. These changes have reduced well-being and quality of life for many older Estonians, while increasing the use of high cost specialist and emergency care. In response, the Estonia Health Insurance Fund (EHIF) is working to support primary care physicians to improve care for complex patients with multiple chronic conditions. A new EHIF-led program, Enhanced Care Management (ECM), entails training family physicians to identify complex patients, co-develop proactive care plans with them, and to undertake more active outreach to and management of these patients.

Conditions

Multi-morbidity; Non-communicable Diseases

Keywords

non-communicable diseases; diabetes; hypertension; obesity; mental health

Outcome Measures

Primary Outcomes (6)

• Number of Participants with primary health care utilization

  number of primary health care service interactions

  through study completion, an average of 2 years

• Number of Participants with inpatient care interactions

  number of hospitalizations

  through study completion, an average of 2 years

• Number of Participants with outpatient services

  number of times ambulatory services accessed

  through study completion, an average of 2 years

• Number of Participants with avoidable hospital admissions

  number of hospital admissions with asthma, COPD, diabetes, congestive heart failure, or hypertension as primary diagnosis

  through study completion, an average of 2 years

• Number of Participants with emergency department visits

  number of emergency department visits for any reason

  through study completion, an average of 2 years

• Number of Participants with hospital readmission

  Inpatient readmission within 90 days after any previous inpatient admission

  through study completion, an average of 2 years

Secondary Outcomes (18)

• Number of Participants with inpatient post-hospitalization services

  through study completion, an average of 2 years

• Number of Participants with outpatient post-visit services

  through study completion, an average of 2 years

• Number of Participants with telephone follow up contacts

  through study completion, an average of 2 years

• Number of Participants with chronic illness-related follow up contacts

  through study completion, an average of 2 years

• Number of diabetes, hypertension and myocardial infarction patients with monitoring of glycosylated Hb (HbA1C)

  through study completion, an average of 2 years

Study Arms (2)

ECM intervention arm

The Enhanced Care Management (ECM) intervention consists of training and coaching family physicians and their teams to develop holistic care and pro-active outreach plans for chronically ill patients or those vulnerable to developing chronically illnesses, as identified and agreed between the enrolled providers and the Estonian Health Insurance Fund (EHIF). The core goal of ECM is to improve the quality of care provided to complex patients, including by increasing the use of preventive care, improving coordination of care across health system levels, and increasing patient involvement in care. These elements can improve patient health and quality of life, and may reduce the need for curative medical services.

Behavioral: Enhanced Care Management

Control

The control group will not receive any intervention.

Interventions

Enhanced Care Management BEHAVIORAL

ECM aims to enable primary health care providers to coordinate care for patients with complex medical needs. It involves the close coordination of services across all treatment modalities and clinical team members, including primary care physicians, specialists, pharmacists, and other healthcare professionals. Providers undertake: Comprehensive care planning: A comprehensive care plan is developed and updated by all members of the patient's healthcare team, including their primary care physician, specialist, and other providers, to ensure that all aspects of treatment are addressed. Proactive outreach: Outreach activities, such as phone calls, home visits, and other forms of contact with the patient and their family are also used to promote patient engagement in health management Monitoring: Close monitoring of patients and their health conditions is essential to ensure that treatments are effective and that any adverse effects are quickly identified and addressed

Also known as: ECM coaching

ECM intervention arm

Eligibility Criteria

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

Study Population

All clinics and individuals covered by the Estonian Health Insurance Fund and determined to be eligible for Enhanced Care Management

You may qualify if:

• identified by general practitioner as having multiple chronic health conditions including type 2 diabetes, hypertension, and obesity

You may not qualify if:

• terminal illness; acute cancer (cancer in treatment), schizophrenia, dialysis due to renal failure, congenital malformations requiring specialized care, and rare diseases; patients with more than 7 chronic conditions

Sponsors & Collaborators

• Harvard School of Public Health (HSPH): lead
• World Bank: collaborator
• Georgetown University: collaborator
• Estonia Health Insurance Fund: collaborator

Study Sites (1)

Estonia Health Insurance Fund

Tallinn, Harju, 10113, Estonia

Location

MeSH Terms

Conditions

Noncommunicable Diseases; Diabetes Mellitus; Hypertension; Obesity; Psychological Well-Being

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Vascular Diseases; Cardiovascular Diseases; Overweight; Overnutrition; Nutrition Disorders; Body Weight; Signs and Symptoms; Personal Satisfaction; Behavior

Study Officials

• Kevin Croke, Phd

  Harvard University

  PRINCIPAL INVESTIGATOR

• Daniel Rogger, PhD

  World Bank

  PRINCIPAL INVESTIGATOR

• Benjamin Daniels, MSc

  Georgetown University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: PROSPECTIVE
• Target Duration: 2 Years
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Global Health

Study Record Dates

• First Submitted: February 15, 2023
• First Posted: April 26, 2023
• Study Start: November 24, 2020
• Primary Completion: June 30, 2022
• Study Completion: May 31, 2023
• Last Updated: August 15, 2023

Record last verified: 2023-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: ANALYTIC CODE
• Time Frame: Post-conclusion of analysis; indefinitely.
• Access Criteria: Use for research only; per agreement with EHIF.

Locations

ES (1)