Clinical trial NCT03100526: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project
Official title: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Primary Health Care
Health Care Costs
Keywords: High-Risk Patients
Lead sponsor: Veteran Affairs Office of Patient Care Services
Sponsor class: FED
Collaborators: name: VA Office of Research and Development
name: VA Palo Alto Health Care System
name: US Department of Veterans Affairs
First posted: 2017-04-04
Enrollment: 2210
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Purpose: Implement a Patient Aligned Care Team (PACT) model that identifies and proactively manages Veterans at the highest risk for hospital admission and death while the patient is still in the ambulatory care setting.

Goal:

* Reduce emergency department and urgent care utilization, hospitalization, and mortality in complex, high risk patients
* Improve Veteran and staff satisfaction

Objectives:

* Maintain the patient in the home setting as much as possible
* Secure appropriate home environment to facilitate health and well-being
* Utilize comprehensive team-based care
* Engage appropriate Veteran Health Administration (VHA) programs to provide interdisciplinary, coordinated, and timely management of complex medical issues


Eligibility criteria: Inclusion Criteria:

* selected for intensive management

Exclusion Criteria:

* enrolled in other intensive case management at VA

Primary outcomes:
measure: VA health care cost
timeFrame: 2 years (two 1-year points)
Secondary outcomes:
measure: Healthcare Utilization
timeFrame: 2 years (two 1-year points)
measure: Total Medicare Cost
timeFrame: 2 years (two 1-year points)
measure: Total Medicare Utilization
timeFrame: 2 years (two 1-year points)
Other outcomes:
measure: Patient Engagement
timeFrame: 2 years (two 1-year points)
measure: Functional status
timeFrame: 2 years (two 1-year points)
measure: Patient Quality of Life Status
timeFrame: 2 years (two 1-year points)
measure: Patient Symptom Burden
timeFrame: 2 years (two 1-year points)
measure: Anxiety
timeFrame: 2 years (two 1-year points)
measure: Substance Abuse
timeFrame: 2 years (two 1-year points)
measure: Cognitive Status
timeFrame: 2 years (two 1-year points)
measure: Pain level
timeFrame: 2 years (two 1-year points)
measure: Shortness of Breath
timeFrame: 2 years (two 1-year points)
measure: Problems with constipation
timeFrame: 2 years (two 1-year points)
measure: Sleep Problems
timeFrame: 2 years (two 1-year points)
measure: Level of Fatigue
timeFrame: 2 years (two 1-year points)
measure: Risk of Falls
timeFrame: 2 years (two 1-year points)
measure: Implementation Outcome/challenges
timeFrame: 2 years (two 1-year points)
measure: Primary Care Staff Job Satisfaction
timeFrame: 3 years (two waves)
measure: Primary Care staff Intention to Stay at the VA
timeFrame: 3 years (two waves)
Locations:
Study officials:
affiliation: VAGLAHS- WLA
name: Lisa Rubenstein, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Ann Intern Med. 2018 Jun 19;168(12):846-854. doi: 10.7326/M17-3039. Epub 2018 Jun 5.
citation: Chang ET, Zulman DM, Asch SM, Stockdale SE, Yoon J, Ong MK, Lee M, Simon A, Atkins D, Schectman G, Kirsh SR, Rubenstein LV; PIM Executive Committee and Demonstration Sites. An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation. Contemp Clin Trials. 2018 Jun;69:65-75. doi: 10.1016/j.cct.2018.04.008. Epub 2018 Apr 23.