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Enhancing and Scaling a High-Touch Home-based Primary Care Program

Enhancing and Scaling a High-Touch Home-based Primary Care Program

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03545698
Enrollment
56
Registered
2018-06-04
Start date
2018-06-26
Completion date
2019-06-19
Last updated
2019-07-29

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

Conditions

Caregiver Stress, Satisfaction, Consumer

Brief summary

The overall goal of the West Health Institute-Northwell PRP is to identify a clinical and economic model that can support scaling the Northwell House Calls program within a four year implementation period, while maintaining the same level of quality, patient/caregiver satisfaction, and high touch provider-patient communication that the program is known for. The Clinical Trial portion of this study refers to the secondary endpoint listed below.

Detailed description

Primary Endpoint: Northwell's House Calls program will be effectively scaled to maintain a patient census of 2000 without compromising patient and caregiver satisfaction. Secondary Endpoint: The telehealth platform, Avizia, effectively improves communication of patient and caregiver needs to House Calls staff, and overall program satisfaction. In order to achieve the secondary endpoint, a telehealth platform will be implemented that will allow patients and their caregivers to teleconference with their care manager, who is either a nurse or a social worker, replacing a typical visit which is completed telephonically. Hypotheses to be tested through a home based telehealth intervention : * Maintain longitudinal non-inferiority of: in-person acute care home visits from a provider, in-person acute care home visits from a care manager, hospitalizations, ED visits, Community Paramedicine deployments, Community Paramedicine transports to hospital, the patient's acuity level, LACE Score, Charelson Co-Morbidity score and the total number of ADLs group compared to usual care group. * Telehealth acceptability * decrease caregiver stress * Improve program satisfaction * Improve staff satisfaction and engagement

Interventions

OTHERAvizia Telehealth Platform

Avizia will be utilized as a communication tool between home-based caregivers (family members, formal caregivers, or informal caregivers) and the House Calls care management team.

Sponsors

Gary and Mary West Health Institute
CollaboratorOTHER
Northwell Health
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

* Patients from the chronic and complex phone-only acuity level, from House Calls, Advanced Illness Management, Northwell Health Solutions. * If possible, we will recruit both patient and caregiver dyads. * The caregiver can be a family member or a paid caregiver. * If patients are cognitively impaired, then they must have a caregiver who can verbally confirm that they will be present with the patient for the telehealth visit. -Caregiver must be present during Avizia enrollment with the research staff to ensure proper use of the device. * The eligible patient or the eligible caregiver, must have a mobile phone number or email address listed in Allscripts is the associated chart, in order to participate in an Avizia visit with House Calls. * Patients will be able to participate in the study regardless of cognitive impairment, if they have a caregiver who is able to consent on their behalf. This caregiver must be their power of attorney or family member, but does not have the be the caregiver present for the Avizia visit.

Exclusion criteria

* Patients under 18 * Patients that are cognitively impaired and unable to use the device, who also do not have a present and willing caregiver who can use the device. * If the patient and willing caregiver do not have an email address or phone number listed on the associated chart on Allscripts. * Patient or caregiver does not have a smart phone, tablet, laptop or desktop computer able to launch Avizia.

Design outcomes

Primary

MeasureTime frameDescription
Telehealth Acceptability Among Geriatric, Homebound patients12 monthsThe proportion of geriatric patients who agree to use telehealth for a care management visit in lieu of a phone call visit, out of those who are offered the service.

Secondary

MeasureTime frameDescription
Telehealth Completion Success12 monthsThe proportion of telehealth visits that are completed successfully, out of those that are scheduled.
Telehealth Satisfaction Among Geriatric Patients12 monthsThe sum and average of scores across domains on the Telemedicine Satisfaction Questionnaire.
Telehealth Satisfaction Among RNs and Social Workers12 monthsThe sum and average of scores across domains on the Telemedicine Satisfaction Questionnaire, adapted from original use with providers to use with care management staff (RNS and Social Workers).

Countries

United States

Outcome results

None listed

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