Comprehensive Care Models for Medicare Patients
What You Need to Know Before You Apply
What is the purpose of this trial?
This randomized trial is evaluating whether socioeconomically disadvantaged Medicare patients at increased risk of hospitalization experience fewer hospitalization if those patients are offered care in: 1) ACCT, where patients receive care from different physicians in the hospital and the clinic settings and have access to nurse and social worker care coordination services, 2) CCP where patients receive care from one physician in the inpatient and outpatient settings or 3) C4P which adds screening of unmet social needs, community health worker support and arts and culture programming to CCP. The study will determine how these programs affect patient activation and engagement in care, satisfaction with care, general health and mental health, and goal attainment.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
Is the Comprehensive Care Models for Medicare Patients program safe for humans?
How is the Comprehensive Care Models for Medicare Patients treatment different from other treatments?
This treatment is unique because it combines different care models to provide both inpatient and outpatient care by the same physician, aiming to improve coordination and outcomes for patients at high risk of hospitalization. It focuses on comprehensive care through a team approach, which is not commonly found in standard treatments.36789
What data supports the effectiveness of the treatment Ambulatory Care Coordinator Team (ACCT), Comprehensive Care Community & Culture Program (C4P), Comprehensive Care Physician Program (CCP)?
The Comprehensive Care Physician model, which is part of the treatment, focuses on improving care coordination for patients at high risk of hospitalization by having the same physician provide both hospital and outpatient care. This approach aims to improve patient outcomes and reduce costs, although evidence of its effectiveness was still being assessed as of the last report.3561011
Are You a Good Fit for This Trial?
This trial is for socioeconomically disadvantaged Medicare patients who have been hospitalized once in the past 2 years or are currently in the emergency department. It's designed to see if different care approaches can reduce hospital visits.Inclusion Criteria
Exclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Treatment
Participants are assigned to one of three care models: ACCT, CCP, or C4P, and receive care coordination and support services
Follow-up
Participants are monitored for hospitalization rates, patient activation, engagement, satisfaction, and health outcomes
Extension
Optional continuation of care coordination and support services for participants who wish to continue beyond the initial study period
What Are the Treatments Tested in This Trial?
Interventions
- Ambulatory Care Coordinator Team (ACCT)
- Comprehensive Care Community & Culture Program (C4P)
- Comprehensive Care Physician Program (CCP)
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Chicago
Lead Sponsor
Patient-Centered Outcomes Research Institute
Collaborator