Comprehensive Care for Patients at High Risk of Hospitalization
(CCP Trial)
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.12345Why 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?
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
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants receive care from a Comprehensive Care Physician both in outpatient clinics and during hospitalizations
Follow-up
Participants are monitored for health outcomes, care utilization, and patient satisfaction
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?
2
Treatment groups
Experimental Treatment
Active Control
Patients randomized to the Comprehensive Care group are assigned to a Comprehensive Care physician and are asked to see their assigned CCP for their primary care. The patients will receive their care by the CCP in the outpatient clinic and also if they were to be hospitalized.
If patients are randomized to standard of care, they are not assigned to a Comprehensive Care Physician. They are asked to continue receiving their care as they normally would.
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Chicago
Lead Sponsor
Endeavor Health
Collaborator
University HealthSystem Consortium
Collaborator
University of Illinois at Chicago
Collaborator
Rush University Medical Center
Collaborator
Northwestern University
Collaborator
NorthShore University HealthSystem
Collaborator
Published Research Related to This Trial
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 View
This piece, written by the physician who coined the term "hospitalist," provides an overview of the hospitalist model and reflects on key ...
7.
aha.org
aha.org/guidesreports/2025-03-11-improvement-safety-culture-linked-better-patient-and-staff-outcomesImprovement in Safety Culture Linked to Better Patient and ...
Report shows hospitals outperform pre-pandemic levels, boosting patient safety, care experience and workforce resilience.
8.
aspe.hhs.gov
aspe.hhs.gov/sites/default/files/private/pdf/255906/ProposalUniversityofChicagoMedicine.pdfThe 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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