Clinical trial NCT02320591: Evaluation of the Comprehensive Primary Care Initiative
Official title: Evaluation of the Comprehensive Primary Care Initiative
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Medicare Expenditures, Quality of Care
Lead sponsor: Mathematica Policy Research, Inc.
Sponsor class: OTHER
Collaborators: name: Centers for Medicare and Medicaid Services
First posted: 2014-12-19
Enrollment: 365076
Sex: ALL
Minimum age (years): 21
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This study assesses the effects of the Centers for Medicare and Medicaid Services' Comprehensive Primary Care (CPC) initiative on physician practices, practice staff, Medicare and Medicaid costs and service utilization, quality of care, and patient outcomes. CPC provides financial resources, timely feedback on key practice outcomes, and a learning network to support practice transformation to improve quality of care and lower costs.

Detailed description: CMS selected 7 regions (states or substate areas) to include in this study, based on commitment of other (ie, nonMedicare) payers in the area to provide financial resources to participating practices to support practice transformation to improve quality of care, reduce costs, and improve population health. 497 practices were selected from roughly 1000 applicants in the 7 regions to participate in the study. CMS pays participating practices a per member per month care management fee for each Medicare patient attributed to the practice. The practices also receive quarterly feedback on trends in their Medicare patients' use of hospital and emergency room services, Medicare expenditures, and patient outcomes from periodic surveys. Practices are expected to improve patient outcomes and lower Medicare costs per patient by using the additional resources to improve: risk-stratified care management, access and continuity of care, planned chronic and preventive care, patient and caregiver engagement, and coordination across the medical neighborhood. To remain in the study, practices must meet annual milestones for meaningful use of electronic health records and other practice features. The intervention period, which began in Fall 2012, will continue for 4 years.

Eligibility criteria: Inclusion Criteria:

* Medicare beneficiary attributed to CPC practice or to a matched comparison practice. Patients are attributed to the practice from which they received the most E\&M visits during the 2-year period examined.

Exclusion Criteria:

* Beneficiaries enrolled in a managed care plan.

Primary outcomes:
measure: Medicare expenditures
timeFrame: 12 months
Secondary outcomes:
measure: number of ER visits
timeFrame: 12 months
measure: number of hospital admissions
timeFrame: 12 months
measure: 30-day hospital readmission rate
timeFrame: 30-days
measure: hospital admission for ambulatory care sensitive condition
timeFrame: 12 months
Other outcomes:
Locations:
city: Princeton
country: United States
facility: Mathematica Policy Research
state: New Jersey
Study officials:
affiliation: Mathematica Policy Research
name: deborah peikes, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Centers for Medicare & Medicaid Services
name: Timothy Day, MPP
role: STUDY_DIRECTOR
References:
citation: Peikes DN, Swankoski K, Hoag SD, Duda N, Coopersmith J, Taylor EF, Morrisson N, Palakal M, Holland J, Day TJ, Sessums LL. The Effects of a Primary Care Transformation Initiative on Primary Care Physician Burnout and Workplace Experience. J Gen Intern Med. 2019 Jan;34(1):49-57. doi: 10.1007/s11606-018-4545-0. Epub 2018 Jul 17.
citation: Dale SB, Ghosh A, Peikes DN, Day TJ, Yoon FB, Taylor EF, Swankoski K, O'Malley AS, Conway PH, Rajkumar R, Press MJ, Sessums L, Brown R. Two-Year Costs and Quality in the Comprehensive Primary Care Initiative. N Engl J Med. 2016 Jun 16;374(24):2345-56. doi: 10.1056/NEJMsa1414953. Epub 2016 Apr 13.