Enhancing Complex Care Through an Integrated Care Coordination Information System

Ambulatory Safety and Quality Program: Improving Management of Individuals With Complex Healthcare Needs Through Health It

Status

Completed

Phases

Phase 3

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT01890603

Enrollment

60000

Registered

2013-07-02

Start date

2008-09-30

Completion date

2011-06-30

Last updated

2013-07-02

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Health Information Technology, Nurse Based Care Management

Keywords

Care coordination, primary care, nurse care management, practice facilitation

Brief summary

Cluster randomized controlled trial comparing care coordination incentives to pay for performance (quality measure) incentives in clinics on utilization, cost, quality, and patient experience.

Interventions

OTHERData collection

Research involving materials (data, documents, records, or specimens) that have been collected, or will be collected, solely for non-research purposes (such as medical treatment or diagnosis).

OTHERData Collection

Research involving materials (data, documents, records, or specimens) that have been collected, or will be collected, solely for non-research purposes (such as medical treatment or diagnosis).

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

SUPPORTIVE_CARE

Masking

SINGLE (Subject)

Eligibility

Sex/Gender

ALL

Age

18 Years to 90 Years

Healthy volunteers

Inclusion criteria

* Six Clinics participating whom Care Management Plus team has worked with before * Patients belonging to one of these six clinics * Picked based on an algorithm designed to identify high risk patients. * Clinic will review potential patients list and issue a survey with consent form

Exclusion criteria

* Younger than 18 * Older than 90

Design outcomes

Primary

Measure	Time frame	Description
Rate of Utilization	up to 18 months	Utilization includes Emergency Department visits and hospitalizations for this high risk group.

Secondary

Measure	Time frame	Description
Patient Satisfaction/Experience	0, 18 months	Patient Assessment of Care for Chronic Conditions (PACIC; Consumer Assessment of Healthcare Providers and Systems
Reduce Costs	0, 12, 18 months	Costs will be aggregated and compared across groups
Improve quality of care	0,3,6,9,12,15,18 months	5 pre-validated quality measures will be aggregated and compared across groups.

Countries

United States

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026