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

700 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this pragmatic clinical trial is to learn if it is possible to implement a Primary Hospital Provider (PHP) team that aims to improve continuity of care for patients who are frequently hospitalized. The main question it aims to answer is: Are patients assigned to the PHP team more likely to be assigned to this team during a follow up hospitalization? Researchers will compare this to similar patients assigned to receive usual care. Some participants from both the PHP team and usual care groups will be asked to participate in interviews to help researchers understand the needs of patients who are frequently admitted and the care they receive.

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 data supports the effectiveness of the treatment Primary Hospital Provider Team for Complex Medical Needs?

Research shows that having a fully staffed team and using a team-based approach in primary care can improve the management of patients with complex needs. Teams that include nurses and other healthcare professionals are more likely to use important tools and approaches effectively, which can lead to better patient outcomes. ^{1 2 3 4 5}

Is the Primary Hospital Provider Team for Complex Medical Needs generally safe for humans?

The research articles discuss patient safety and adverse events in healthcare settings, highlighting that miscommunication and errors can lead to harm. However, they do not provide specific safety data for the Primary Hospital Provider Team for Complex Medical Needs. ^{6 7 8 9 10}

How does the Primary Hospital Provider Team treatment differ from other treatments for complex medical needs?

The Primary Hospital Provider Team treatment is unique because it uses a team-based approach, involving various healthcare professionals like nurses, physician assistants, and social workers, to provide comprehensive care for patients with complex medical needs. This differs from traditional treatments that may rely on individual healthcare providers, as it emphasizes coordinated, interdisciplinary care to address a wide range of patient needs. ^{4 5 11 12 13}

Research Team

Sara Westergaard, MD, MPH

Principal Investigator

University of Wisconsin, Madison

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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]

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]

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 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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States 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. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Organizational interventions to implement improvements in patient care: a structured review of reviews. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Multimorbidity patterns in high-need, high-cost elderly patients. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Providing better care for patients with complex needs in acute medicine. [2011]

5. United States pubmed.ncbi.nlm.nih.gov

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

6. Netherlands pubmed.ncbi.nlm.nih.gov

The safe implementation of research into healthcare practice. [2008]

7. United States pubmed.ncbi.nlm.nih.gov

The Safety of Inpatient Health Care. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Adverse events and preventable adverse events in children. [2007]

10. England 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. [2019]

11. United States pubmed.ncbi.nlm.nih.gov

Teamlet structure and early experiences of medical home implementation for veterans. [2021]

12. United States pubmed.ncbi.nlm.nih.gov

PACT ICU Model: Interprofessional Case Conferences for High-Risk/High-Need Patients. [2023]

13. United States pubmed.ncbi.nlm.nih.gov

Comprehensive care of the child with a chronic condition. Part 1. Understanding chronic conditions in childhood. [2019]