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Understanding Perspectives of Frequently-Admitted Hospital Patients (CHAMP)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03097640
Recruitment Status : Completed
First Posted : March 31, 2017
Last Update Posted : October 4, 2021
Sponsor:
Information provided by (Responsible Party):
Bruce Lowell Henschen, Northwestern University

Brief Summary:
This study evaluates the clinical outcomes of a novel program designed to target patients who are high-utilizers of hospital services. Patients who are frequently admitted to medical services - "high-utilizers" - present a unique set of challenges to providers and the health care system that require a different way of approaching chronic illness. The Complex High Admission Management Program (CHAMP) is an innovative model of care consisting of a small team of providers who establish continuity relationships with high-utilizer patients. CHAMP strives to provide effective, high value care via a longitudinal relationship-based care model through provider continuity, intensive case management, and personalized care plans. To better understand the potential outcomes of CHAMP, this study is a longitudinal, prospective, randomized, controlled trial of medical high-utilizers enrolled in CHAMP compared to a group of high-utilizer patients receiving usual care.

Condition or disease Intervention/treatment Phase
Continuity of Patient Care High Utilizers of Hospital Care Patient-Centered Care Other: CHAMP Not Applicable

Detailed Description:

Frequent users of hospital services, otherwise known as hospital "high-utilizers," comprise a diverse patient population that pose unique challenges to the current US health care delivery model. The Complex High Admission Management Program (CHAMP), implemented at Northwestern Memorial Hospital in Chicago, IL, seeks to improve care for high-utilizer patients through provider continuity, intensive case management, and developing personalized care plans that span inpatient, outpatient, and emergency care environments.

Preliminary evaluation of CHAMP has shown a 38% decrease in 30-day unplanned hospital readmissions and an 18% decrease in ED encounters over a 6-month time period, when compared to an equal time period pre-CHAMP.

Patients are eligible for the program if they are readmitted to the hospital three times within a twelve-month period. Due to the time and resource limitations of the CHAMP team, not all patients meeting these criteria can be enrolled at once. Patients will thus be randomly selected to be enrolled in CHAMP or will receive usual care. This study plans to evaluate the difference in outcomes between patients enrolled in CHAMP and those receiving usual care by answering the following questions:

To what extent do high-utilizer patients enrolled in CHAMP differ in their level of trust in providers, self-assessed coping skills, daily symptom burden, perceived functionality, and attitudes about the healthcare system when compared to a control group of high utilizer patients receiving usual care? We will assess patient responses to a series of surveys assessing trust, feelings of discrimination, activation, satisfaction with care, and level of social functioning.

What are the healthcare utilization rates of high-utilizer patients enrolled in CHAMP compared to a control group of high-utilizer patients receiving usual care? We will compare rates of (a) hospital admission and (b) utilization (including length of stay) among high-utilizer patients enrolled in CHAMP as compared to high-utilizer patients not enrolled in the program.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 151 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Health Services Research
Official Title: Understanding Perspectives of Frequently-Admitted Hospital Patients
Actual Study Start Date : November 2016
Actual Primary Completion Date : July 2020
Actual Study Completion Date : October 2021

Arm Intervention/treatment
Experimental: CHAMP
Participants enrolled in CHAMP are followed by a team of a social worker and physician across the care continuum. CHAMP team members visit patients in the ED and on inpatient floors. Along with the patient's input, the team develops an Individualized Care Plan outlining the patient's medical and social history and providing recommendations to other providers on specific aspects of their care. Care plans are reviewed with patients on an individual basis and reviewed periodically by the CHAMP providers. CHAMP-enrolled participants are scheduled for physician and social worker follow-up appointments at the CHAMP clinic; this time is used to provide intensive case management, medical care, and psychosocial support.
Other: CHAMP
CHAMP team members visit patients in the ED and on inpatient floors. Along with the patient's input, the team develops an Individualized Care Plan outlining the patient's medical and social history and providing recommendations to other providers on specific aspects of their care. Care plans are reviewed with patients on an individual basis and reviewed periodically by the CHAMP providers. CHAMP-enrolled participants are scheduled for physician and social worker follow-up appointments at the CHAMP clinic; this time is used to provide intensive case management, medical care, and psychosocial support.

No Intervention: Standard Care
Individuals in the standard care arm will receive care as they do normally when hospitalized, including medical and inpatient social work services, as well as outpatient care from their providers.



Primary Outcome Measures :
  1. Readmission Rate [ Time Frame: 180-days from indexed hospital discharge ]
    180-day Inpatient Readmission Rate (as defined by Medicare) to Northwestern Memorial Hospital


Secondary Outcome Measures :
  1. Readmission Rate [ Time Frame: 30 days from indexed hospital discharge ]
    Inpatient Readmission Rate

  2. Readmission Rate [ Time Frame: 90 days from indexed hospital discharge ]
    Inpatient Readmission Rate

  3. Inpatient Admissions [ Time Frame: 30 days from indexed hospital discharge ]
    Inpatient Admission Rate to Northwestern Memorial Hospital

  4. Inpatient Admissions [ Time Frame: 90 days from indexed hospital discharge ]
    Inpatient Admission Rate to Northwestern Memorial Hospital

  5. Inpatient Admissions [ Time Frame: 180 days from indexed hospital discharge ]
    Inpatient Admission Rate to Northwestern Memorial Hospital

  6. Inpatient Admissions-total [ Time Frame: 30 days from indexed hospital discharge ]
    Inpatient Admissions to all hospitals, as reported by patient

  7. Inpatient Admissions-total [ Time Frame: 90 days from indexed hospital discharge ]
    Inpatient Admissions to all hospitals, as reported by patient

  8. Inpatient Admissions-total [ Time Frame: 180 days from indexed hospital discharge ]
    Inpatient Admissions to all hospitals, as reported by patient

  9. ER Admissions [ Time Frame: 180 days from indexed hospital discharge ]
    ER Visits to Northwestern Memoria

  10. ER Admissions [ Time Frame: 30 days from indexed hospital discharge ]
    ER Visits to Northwestern Memoria

  11. ER Admissions [ Time Frame: 90 days from indexed hospital discharge ]
    ER Visits to Northwestern Memoria

  12. ER Admissions-total [ Time Frame: 30 days from indexed hospital discharge ]
    ER Visits to all hospitals, as reported by patient

  13. ER Admissions-total [ Time Frame: 90 days from indexed hospital discharge ]
    ER Visits to all hospitals, as reported by patient

  14. ER Admissions-total [ Time Frame: 180 days from indexed hospital discharge ]
    ER Visits to all hospitals, as reported by patient

  15. Hospital Length of Stay [ Time Frame: 180 days from indexed hospital discharge ]
    Average Length of Stay at NMH during time period

  16. Hospital Length of Stay [ Time Frame: 30 days from indexed hospital discharge ]
    Average Length of Stay at NMH during time period

  17. Hospital Length of Stay [ Time Frame: 90 days from indexed hospital discharge ]
    Average Length of Stay at NMH during time period

  18. Clinic Visits [ Time Frame: 180 days from indexed hospital discharge ]
    Number of total clinic visits

  19. Patient-Centered Outcomes [ Time Frame: 30 days from indexed hospital discharge ]
    Responses to PROMIS Profile Scales, Trust in Physicians, Patient Activation, and Feelings of Discrimination

  20. Patient-Centered Outcomes [ Time Frame: 90 days from indexed hospital discharge ]
    Responses to PROMIS Profile Scales, Trust in Physicians, Patient Activation, and Feelings of Discrimination

  21. Patient-Centered Outcomes [ Time Frame: 180 days from indexed hospital discharge ]
    Responses to PROMIS Profile Scales, Trust in Physicians, Patient Activation, and Feelings of Discrimination

  22. Average costs [ Time Frame: 180 days from indexed hospital discharge ]
    Estimated cost from billing code data for hospitalizations during time period



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

  • Adults (18 yrs of age or older) who are admitted to Northwestern Memorial Hospital (NMH) and identified by EDW search as having two unplanned 30-day inpatient readmissions to NMH within the prior 12 months with one of two additional criteria:at least 1 readmission in the last 6 months, or a referral from one of that patient's medical providers.
  • Admission to NMH during the study period (October 1, 2016 to September 30, 2018) and meeting criteria described above for CHAMP
  • Ability to consent for this study (including ability to read materials printed in English, understanding and communicating in English, and able to understand the risks and benefits of participating in the study).

Exclusion Criteria:

  • Patients who are admitted to the Intensive Care Unit, patients admitted to Oncology services (as we have found that this latter group has a multidisciplinary care team already in place), or patients actively followed by the Heart Failure Bridge and Transition (BAT) Team, a different quality improvement intervention designed to reduce readmissions among patients admitted for acute decompensated heart failure.
  • Participants will be excluded if they are disoriented to person, place, or time, or are unable to consent for any other reason.
  • Minors, pregnant women, and prisoners will also be excluded.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03097640


Locations
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United States, Illinois
Northwestern Memorial Hospital
Chicago, Illinois, United States, 60611
Sponsors and Collaborators
Northwestern University
Investigators
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Principal Investigator: Bruce L Henschen, MD/MPH Northwestern University Feinberg School of Medicine
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Bruce Lowell Henschen, Assistant Professor, Northwestern University
ClinicalTrials.gov Identifier: NCT03097640    
Other Study ID Numbers: STU00203847
First Posted: March 31, 2017    Key Record Dates
Last Update Posted: October 4, 2021
Last Verified: October 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No