Comorbidities and Coexisting Conditions, Emergencies, Risk Reduction
Conditions
Keywords
High utilizer, High needs, Multimorbidity, Intensive outpatient care, Resident education
Brief summary
Background: A small subset of the patient population is responsible for a significant proportion of healthcare expenditures. These patients are cared for in academic medical centers by internal medicine residents however there has been no research to date about the education or the management of patients with complex multimorbidity in the outpatient setting. Objective: To evaluate the impact of the High Risk Outpatient Intern-led Care (HeROIC) Clinic on internal medicine interns' perceived ability to manage complex outpatients as well as pre and post intervention total patient healthcare cost. Methods: The investigators created the HeROIC outpatient clinic environment to comprise longer visit time slots, bedside presentations, and team-based care (one intern primary care provider, one secondary intern, and one longitudinal attending). All non-preliminary interns based at one primary care site participated in the intervention while interns at a second site continued to practice in the usual outpatient clinic environment. The interns in the HeROIC clinic arm assumed the roles of primary care providers for 34 complex patients in total. The primary outcome was the perceived confidence in the management of complex outpatients as assessed by a survey. Secondary outcomes included perceptions about the ability to provide high-quality outpatient and evidence-based outpatient care, as well as statewide pre-post patient healthcare cost data.
Interventions
OTHERHigh Risk Clinic
Subgroup of primary care clinic where patients have longer time slots, supervision by one longitudinal attending, bedside presentations
Sponsors
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ≥ 6 medical comorbidities * ≥ 2 admissions past 6 months or ≥ 4 past 1 year * New or returning patient in resident primary care clinic
Exclusion criteria
* Primary mental health disease driving hospitalizations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Inpatient or ER visits | Up to 2 years post enrollment | Presentations to the ER and hospitalizations |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total medical cost | Up to 2 years post enrollment | Total medical costs (Outpatient, Inpatient, Imaging, Labs) |
Countries
United States
Outcome results
None listed