High Risk Outpatient Intern-led Care (HeROIC) Clinic Initiative

Study Overview
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Brief Summary
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Background: A small subset of the patient population is responsible for a significant proportion of healthcare expenditures. These patients are cared for in academic medical centers by internal medicine residents however there has been no research to date about the education or the management of patients with complex multimorbidity in the outpatient setting. Objective: To evaluate the impact of the High Risk Outpatient Intern-led Care (HeROIC) Clinic on internal medicine interns' perceived ability to manage complex outpatients as well as pre and post intervention total patient healthcare cost. Methods: The investigators created the HeROIC outpatient clinic environment to comprise longer visit time slots, bedside presentations, and team-based care (one intern primary care provider, one secondary intern, and one longitudinal attending). All non-preliminary interns based at one primary care site participated in the intervention while interns at a second site continued to practice in the usual outpatient clinic environment. The interns in the HeROIC clinic arm assumed the roles of primary care providers for 34 complex patients in total. The primary outcome was the perceived confidence in the management of complex outpatients as assessed by a survey. Secondary outcomes included perceptions about the ability to provide high-quality outpatient and evidence-based outpatient care, as well as statewide pre-post patient healthcare cost data.

Official Title
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Impact of a Novel Complex Outpatient Clinic Setup on Patient Outcomes and Intern Education

Conditions
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Comorbidities and Coexisting Conditions, Risk Reduction, Emergencies

Intervention / Treatment
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* Other: High Risk Clinic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥ 6 medical comorbidities ≥ 2 admissions past 6 months or ≥ 4 past 1 year New or returning patient in resident primary care clinic Exclusion Criteria: Primary mental health disease driving hospitalizations

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard Care<br> | |
| Experimental: Complex Clinic Arm<br> | Other: High Risk Clinic<br>* Subgroup of primary care clinic where patients have longer time slots, supervision by one longitudinal attending, bedside presentations<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Inpatient or ER visits | Presentations to the ER and hospitalizations | Up to 2 years post enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total medical cost | Total medical costs (Outpatient, Inpatient, Imaging, Labs) | Up to 2 years post enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High needs, Multimorbidity, Intensive outpatient care, Resident education, High utilizer