Primary Hospital Provider Team for Complex Medical Needs

(PHP Team Trial)

Overseen By Sara Westergaard, MD, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Oncologic diagnosis, Prisoners, Pregnant, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a Primary Hospital Provider (PHP) team can improve care for patients frequently hospitalized. Researchers seek to discover whether patients assigned to this special team receive more consistent care during future hospital stays compared to those receiving usual care. The study seeks adults who have been hospitalized at least twice in the past year and are at high risk for readmission. Participants might also join interviews to share their experiences and needs. As an unphased study, this trial offers patients the chance to contribute to innovative care strategies that could enhance hospital experiences for many.

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 Primary Hospital Provider Team is safe for patients with complex medical needs?

Research has shown that teamwork in healthcare can enhance patient safety. Effective team collaboration improves communication and care coordination, reducing errors.

While specific safety data for the Primary Hospital Provider (PHP) Team is not available, this approach involves a team supporting patients frequently in the hospital. The aim is to provide consistent care, helping to prevent complications.

As this trial focuses on improving care through teamwork rather than testing a new drug or device, the primary safety concern is the team's collaboration quality. Studies have demonstrated that healthcare teams prioritizing communication and coordination can improve patient safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Primary Hospital Provider (PHP) Team approach because it offers a fresh way to manage complex medical needs. Unlike the standard care, which typically involves a usual care hospital medicine team, the PHP Team focuses on a more integrated approach to patient care. This method aims to enhance patient outcomes by fostering better communication and coordination among healthcare professionals. By streamlining how care is delivered, this approach has the potential to improve efficiency and the overall patient experience, setting it apart from traditional hospital care models.

What evidence suggests that the Primary Hospital Provider Team is effective for improving continuity of care?

Research has shown that a dedicated Primary Hospital Provider (PHP) team, one of the treatment options in this trial, can enhance care for patients with complex medical needs. Studies have found that focused primary care programs reduce hospital stays and emergency visits. By providing continuous and coordinated care, these teams aim to deliver more effective and timely treatment. Different healthcare specialists work together to manage complex cases more efficiently. Overall, these methods lead to better health outcomes and more personalized care for patients frequently admitted to the hospital. ^{1 6 7 8 9}

Who Is on the Research Team?

Sara Westergaard, MD, MPH

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

This trial is for adults over 18 who've been hospitalized at least twice in the past year at UW Health and have a high readmission risk score. It's not suitable for those with less frequent hospitalizations or lower risk scores.

Inclusion Criteria

I am older than 18 years.

I've been hospitalized twice or more at UW Health in the last year and have a high readmission risk score.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of the Primary Hospital Provider (PHP) team to improve continuity of care for frequently hospitalized patients

11.5 months

Follow-up

Participants are monitored for readmission rates and qualitative feedback through interviews and focus groups

11.5 months

What Are the Treatments Tested in This Trial?

Interventions

• Primary Hospital Provider Team

Trial Overview

The study tests if a Primary Hospital Provider (PHP) team can improve care continuity for patients often hospitalized, by seeing if they're more likely to be reassigned to this team compared to usual care during follow-up stays.

How Is the Trial Designed?

Group I: PHP Team Experimental Treatment 1 Intervention

PHP Team

Group II: Usual Care Active Control 1 Intervention

Usual Care hospital medicine team

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Published Research Related to This Trial

Adverse events occurred in 1% of pediatric hospitalizations, with 0.6% being preventable, indicating that a significant number of children experience harm due to medical management rather than their underlying conditions.

The most common types of preventable adverse events were birth-related (32.2%) and diagnostic-related (30.4%), highlighting the need for targeted research and interventions in these areas to improve patient safety in pediatric care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events and preventable adverse events in children. Woods, D., Thomas, E., Holl, J., et al.[2007]

The study analyzed 1183 patient safety incident reports in primary care, revealing that 572 (48%) involved harm to vulnerable children, highlighting a significant safety issue in healthcare for this group.

Key safety concerns included inadequate recognition of children's needs, lack of access to accurate information by providers, and delays in referrals, indicating systemic failures that need to be addressed to improve care for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports. Omar, A., Rees, P., Cooper, A., et al.[2020]

This study aims to assess the frequency and types of adverse events in Australian pediatric care by reviewing 6000-8000 medical records of children under 16 years from various healthcare settings during 2012 and 2013.

The research will utilize a modified version of the Global Trigger Tool for data collection, which is a systematic approach to identifying potential safety issues in healthcare, highlighting the importance of improving patient safety in children's healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CareTrack Kids-part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review. Hibbert, PD., Hallahan, AR., Muething, SE., et al.[2019]

A review of 36 studies on organizational strategies in patient care found that while some strategies, like multidisciplinary teams and integrated care services, generally improved patient outcomes, the effects were inconsistent across different approaches.

The revision of professional roles and the use of computer systems for knowledge management were associated with improved professional performance, but overall, the evidence for predicting the effectiveness of any specific strategy remains uncertain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Organizational interventions to implement improvements in patient care: a structured review of reviews. Wensing, M., Wollersheim, H., Grol, R.[2023]

Healthcare trainees and staff collaborate to create proactive, team-based care plans aimed at addressing the chronic care needs of high-risk patients.

This interprofessional approach enhances the quality of care by ensuring that multiple perspectives and expertise are integrated into the management of complex patient needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PACT ICU Model: Interprofessional Case Conferences for High-Risk/High-Need Patients. Gardner, AL., Weppner, WG., Willis, J., et al.[2023]

The paper proposes a dual approach to improve patient safety by developing a care pathway modeling system that enhances understanding of interdisciplinary interactions and provides quick access to clinical knowledge.

It emphasizes the importance of addressing human behavioral factors that can compromise patient safety and suggests applying risk management techniques from high-stress environments to healthcare decision-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The safe implementation of research into healthcare practice. Manning, B., Benton, S.[2008]

The implementation of the Patient Aligned Care Teams (PACT) model at the VA showed promise in enhancing primary care experiences for Veterans, despite challenges such as limited training and unclear roles among teamlet members.

Feedback from 41 frontline teamlet members indicated that better-defined responsibilities and improved communication are crucial for the success of the teamlet model, highlighting the need for more comprehensive training and support from leadership.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teamlet structure and early experiences of medical home implementation for veterans. Rodriguez, HP., Giannitrapani, KF., Stockdale, S., et al.[2021]

Children with chronic illnesses and disabilities benefit significantly from comprehensive and coordinated healthcare services, which support their unique needs and those of their families.

Primary care pediatricians are ideally positioned to coordinate these services, but they face various challenges in effectively managing the care of children with special health care needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive care of the child with a chronic condition. Part 1. Understanding chronic conditions in childhood. Desguin, BW., Holt, IJ., McCarthy, SM.[2019]

Nurses rated various tools and care approaches for patients with complex needs as significantly more important than primary care providers, highlighting the critical role of nursing in patient care.

Having a fully staffed healthcare team was associated with higher ratings of importance for care tools, suggesting that adequate staffing enhances the perceived value and usage of these tools in managing complex patient needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors Associated With Patient-Centered Medical Home Teams' Use of Resources for Identifying and Approaches for Managing Patients With Complex Needs. Stockdale, SE., Rose, DE., McClean, M., et al.[2023]

A multi-professional approach to assessing patients with complex needs in the Medical Assessment Unit at Edinburgh Royal Infirmary was implemented, highlighting the importance of teamwork in acute medical care.

The study reviewed data over a 4-week period, indicating that this innovative method could improve patient management and outcomes for those requiring acute medical attention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Providing better care for patients with complex needs in acute medicine. Crosswaite, AG., Dougall, H., Duguid, I., et al.[2011]

In a study of 2809 hospital admissions, 23.6% experienced at least one adverse event, highlighting a significant issue in patient safety during hospitalization.

Of the identified adverse events, 22.7% were deemed preventable, indicating that improvements in hospital practices could reduce patient harm, particularly from adverse drug events, which were the most common type.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Safety of Inpatient Health Care. Bates, DW., Levine, DM., Salmasian, H., et al.[2023]

Modern medicine emphasizes teamwork, involving various healthcare professionals such as nurses, physician assistants, and pharmacists, to provide comprehensive care.

The Patient Centered Medical Home (PCMH) model aims to address 85%-90% of patients' needs by offering a wide range of services, enhancing the overall effectiveness of primary care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Observations from home: The patient centered medical home, integrated behavioral healthcare, teams and teamwork. Kallenberg, GA.[2017]

The study identified five common disease clusters among elderly patients with complex health care needs, including metabolic-ischemic heart diseases, neurological and mental disorders, cardiac diseases, respiratory conditions, and neoplasms.

Understanding these disease patterns can help tailor care delivery and interventions for patients with similar chronic conditions, potentially improving the efficiency and effectiveness of health care services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multimorbidity patterns in high-need, high-cost elderly patients. Buja, A., Claus, M., Perin, L., et al.[2020]

Citations

1.

withpower.com

withpower.com/trial/phase-high-need-high-complexity-9-2024-87f64

Primary Hospital Provider Team for Complex Medical Needs

What data supports the effectiveness of the treatment Primary Hospital Provider Team for Complex Medical Needs? Research shows that having a fully staffed team ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12050017/

Exploring Hospital Healthcare Providers' Approaches to ...

This study explores hospital healthcare providers' views on multidisciplinary collaboration and their openness to an intervention for managing complex care.

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5698228/

Effectiveness of Intensive Primary Care Interventions

In this study, we systematically reviewed the impact of intensive primary care programs on all-cause mortality, hospitalization, and emergency department use.

4.

onlinelibrary.wiley.com

onlinelibrary.wiley.com/doi/10.1111/jocn.70102

Implementation Outcomes and Their Determinants for ...

Improving care coordination is critical for providing timely, effective, safe, efficient and equitable patient-centred care (Kizer 2015).

5.

jhmhp.amegroups.org

jhmhp.amegroups.org/article/view/6598/html

considerations for implementing team-based primary care

This qualitative study examines the practices and strategies primary care teams use to provide comprehensive care to complex, vulnerable patients.

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10508386/

Viewpoint: Patient safety in primary care - PubMed Central - NIH

Promoting and maintaining patient safety in primary care requires different strategies and monitoring than utilized in large healthcare delivery systems.

7.

bmcprimcare.biomedcentral.com

bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01879-5

Decision-making and related outcomes of patients with ...

A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care.

8.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6361117/

Teamwork in Healthcare: Key Discoveries Enabling Safer ...

In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the ...

9.

psnet.ahrq.gov

psnet.ahrq.gov/perspective/patient-safety-office-based-care-settings

Patient Safety in Office-Based Care Settings | PSNet

Safety events in ambulatory care fall into four main categories: diagnostic testing errors, medication events, falls, and security or safety incidents.