Multiple Co-morbidities
Conditions
Keywords
Medical informatics, Health services accessibility
Brief summary
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.
Detailed description
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
Interventions
BEHAVIORALEnhanced patient-centered care
The experimental arm will be referred to a multi-disciplinary clinic
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Cook County Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 110 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| NIH PROMIS 10-item short form quality of life | 6 months | We will assess the physical and mental components of the quality of life instrument |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MSAS physical symptom score | 6 months | — |
| Healthcare utilization | 6 months | We will monitor healthcare utilization within our system. To include visits to the emergency room, clinics, and hospitalizations. |
Countries
United States
Outcome results
None listed