Understanding Perspectives of Frequently-Admitted Hospital Patients
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/23/2018 |
| Start Date: | November 2016 |
| End Date: | October 2021 |
| Contact: | Claire A Knoten, PhD/MS |
| Email: | claire.knoten@northwestern.edu |
| Phone: | 312-926-5898 |
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.
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.
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.
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.
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.
We found this trial at
1
site
251 E Huron St
Chicago, Illinois 60611
Chicago, Illinois 60611
(312) 926-2000
Principal Investigator: Bruce L Henschen, MD/MPH
Phone: 312-926-5898
Northwestern Memorial Hospital Northwestern Memorial is an academic medical center hospital where the patient comes...
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