Computer Assisted Symptom Evaluation of Complex Patients (CASE)

• MSAS physical symptom score [ Time Frame: 6 months ] [ Designated as safety issue: No ]
• Healthcare utilization [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  We will monitor healthcare utilization within our system. To include visits to the emergency room, clinics, and hospitalizations.

Patients who have advanced or multiple chronic illnesses present management difficulties for primary care providers. Acute medical issues and limited time for patient evaluation can complicate complete assessment of physical symptoms that directly impact a patient's quality of life. The Cook County Health and Hospitals System (CCHHS) established an Advanced Illness Management Clinic to provide care for complex patients. Patient entry into the Advanced Illness Management Clinic is by referral only, a passive process. After discharge, general medicine clinic patients who do not have a medical provider are given an appointment in the clinic. Since the hospital is the source of many patients, this guarantees that these patients will have at least one illness advanced enough to require hospitalization, and most will have additional chronic illnesses. An outpatient palliative care clinic located in a specialty clinic setting was initiated in 2004. The goal of the clinic was to extend the benefits realized by hospital patients, for whom palliative care consultation has been available for many years, to patients cared for in the outpatient setting. The benefits provided include physical symptom management, spiritual counseling, and support for social issues. Until recently, this outpatient palliative care model has mainly served patients with malignancy. With the addition of the Advanced Illness Management Clinic, palliative care clinicians now can provide care to patients with other chronic and serious illness in the primary care setting.

Hypothesis: Complex patients will have improved quality of life and a reduced symptom burden if seen by a multidisciplinary clinic post-hospitalization, compared to usual care in a general medicine clinic.

Outcome measures:

1. Quality of life as measured by the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) short form
2. Physical symptom burden as measured by the Memorial Symptom Assessment Scale (MSAS), short form

• No Intervention: Usual care
  Intervention: Behavioral: Enhanced patient-centered care
• Experimental: Enhanced patient-centered care
  Patients will be evaluated and treated in the advanced illness management clinic
  Intervention: Behavioral: Enhanced patient-centered care

Inclusion Criteria:

• English or Spanish speaker
• Must be a general medicine clinic patient
• Must have a physical symptom score on MSAS above threshold (i.e., 1.0 or higher)
• Must have a phone number for contact

Exclusion Criteria:

• Visual or cognitive impairment