Comprehensive Care for Patients at High Risk of Hospitalization

(CCP Trial)

AC
GR
Overseen ByGregory Ruhnke, MD
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: University of Chicago
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new method of caring for patients at high risk of hospitalization. Patients will either continue their usual care or receive care from a special doctor who focuses solely on high-risk patients, providing regular check-ups and hospital care if needed. This approach, known as Comprehensive Care, aims to determine if focused care can reduce hospital visits and overall medical costs. Medicare recipients hospitalized at least once in the past year might be suitable for this trial. As an unphased trial, it offers patients the chance to contribute to innovative care strategies that could enhance healthcare outcomes for high-risk individuals.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this model of care is safe for patients at high risk of hospitalization?

Research shows that the Comprehensive Care model targets patients who frequently require hospital care. Since 2012, thousands of Medicare patients have used this approach. It tests a new way of organizing care, not a new drug or treatment.

Studies indicate that this model improves patient care by assigning a dedicated doctor to each patient, enhancing safety and the overall care experience. However, some reports suggest mixed results, such as slightly longer hospital stays for some patients.

Overall, as this is a new way to manage care rather than a new medication, the risks relate more to care organization than to medical side effects.12345

Why are researchers excited about this trial?

Researchers are excited about Comprehensive Care because it offers a more integrated approach to patient management, particularly for those at high risk of hospitalization. Unlike standard care, where patients see various physicians, Comprehensive Care assigns a dedicated physician who oversees all aspects of a patient's health, both in outpatient settings and during any hospital stays. This consistency in care aims to improve patient outcomes by ensuring continuity and a deeper understanding of each patient's unique health needs. By potentially reducing hospital admissions through more personalized and continuous care, this approach could revolutionize how we manage patients with complex health conditions.

What evidence suggests that this model of care is effective for reducing hospitalizations?

Research has shown that the Comprehensive Care model, which participants in this trial may receive, can help reduce hospital stays for high-risk patients. One study found that when doctors focus on these patients, care and consistency improve. This often results in fewer hospital visits, lowering costs. Another study found that this model enhances health outcomes, especially for chronic illnesses, by providing regular care both in and out of the hospital. The model aims to keep patients healthier by ensuring they receive continuous care from the same doctor, improving the quality of care. Meanwhile, participants in the standard of care arm will continue receiving their usual care without assignment to a Comprehensive Care Physician.16789

Who Is on the Research Team?

DM

David Meltzer, MD, PhD

Principal Investigator

University of Chicago

Are You a Good Fit for This Trial?

This trial is for Medicare recipients who have been hospitalized at least once in the past year and are considered high risk for future hospitalizations. The goal is to provide these patients with a dedicated physician who manages their care both during hospital stays and outpatient clinic visits.

Inclusion Criteria

I am on Medicare and was hospitalized at least once last year.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive care from a Comprehensive Care Physician both in outpatient clinics and during hospitalizations

Up to 3 years
Regular visits as needed based on patient condition

Follow-up

Participants are monitored for health outcomes, care utilization, and patient satisfaction

Up to 3 years
Quarterly assessments

What Are the Treatments Tested in This Trial?

Interventions

  • Comprehensive Care
Trial Overview The trial tests a new care model where high-risk patients receive integrated inpatient and outpatient services from the same physician, aiming to reduce hospitalizations and costs. Five physicians will each manage about 200 patients, focusing on continuity of care.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Active Control
Group I: Comprehensive CareExperimental Treatment1 Intervention
Group II: Standard of CareActive Control1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Chicago

Lead Sponsor

Trials
1,086
Recruited
844,000+

Endeavor Health

Collaborator

Trials
135
Recruited
742,000+

University HealthSystem Consortium

Collaborator

Trials
2
Recruited
2,000+

University of Illinois at Chicago

Collaborator

Trials
653
Recruited
1,574,000+

Rush University Medical Center

Collaborator

Trials
448
Recruited
247,000+

Northwestern University

Collaborator

Trials
1,674
Recruited
989,000+

NorthShore University HealthSystem

Collaborator

Trials
134
Recruited
740,000+

Published Research Related to This Trial

Patient outcomes research can enhance the quality of care by improving how healthcare is delivered, focusing on both structures and processes.
Collaboration among different healthcare disciplines is essential for effectively analyzing outcomes, which can help identify cost-effective practices that lead to better patient results.
Outcomes analysis: methods and issues.Jones, KR.[2019]
In a study of 1047 patients at a large teaching hospital, 17.7% experienced serious adverse events, with longer hospital stays increasing the likelihood of such events by about 6% for each additional day.
The majority of adverse events were linked to individual errors (37.8%) or interactive causes (15.6%), highlighting the need for healthcare providers to focus on these areas for proactive error prevention.
An alternative strategy for studying adverse events in medical care.Andrews, LB., Stocking, C., Krizek, T., et al.[2022]
In a study of 182 patients aged 20-69 with femoral neck fractures treated with internal fixation, 73% of those with displaced fractures and 85% with non-displaced fractures reported good or excellent functional outcomes at 24 months.
Despite a significant percentage achieving good functional outcomes, patients did not fully regain their pre-fracture health-related quality of life, indicating that while surgical intervention is effective, it may not restore overall quality of life.
Good functional outcome but not regained health related quality of life in the majority of 20-69 years old patients with femoral neck fracture treated with internal fixation: A prospective 2-year follow-up study of 182 patients.Campenfeldt, P., Hedström, M., Ekström, W., et al.[2018]

Citations

Effectiveness of care models for chronic disease ...To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic ...
Evaluation of a Chronic Care Management Model for ...Chronic care management is effective. Barriers to program durability include dependence on the provider–nurse duo to carry out ...
Teamwork and its impact on chronic disease clinical ...This study aims to review studies with team interventions with selected chronic diseases and identify team components and their impact on key clinical ...
Redesigning Care For Patients At Increased ...We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization.
Operationalizing the Chronic Care Model with Goal ...In this paper, we build on each of the elements of the Chronic Care Model with person-centered, goal-oriented care and provide clinical examples on how to ...
The Comprehensivist Model of Care: A Hospitalist's ViewThis piece, written by the physician who coined the term "hospitalist," provides an overview of the hospitalist model and reflects on key ...
Improvement in Safety Culture Linked to Better Patient and ...Report shows hospitals outperform pre-pandemic levels, boosting patient safety, care experience and workforce resilience.
The Comprehensive Care Physician Payment Model (CCP ...Since 2012, we have enrolled 2,000 Medicare patients at increased risk of hospitalization in a randomized clinical trial at the University of ...
The implementation and impacts of the Comprehensive Care ...More than one-fourth of respondents believed there were worsened outcomes in length of stay (26%, n = 88), 30-day readmission (28%, n = 94), ...
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