Improving How Older Adults at Risk for Cardiovascular Outcomes Are Selected for Care Coordination

Part of paid clinical trials in New York, New York.

Sponsor
Weill Medical College of Cornell University
Study ID
NCT05820295
Status
Completed

Conditions

Eligibility Criteria

Sex
ALL
Age
65 Years - N/A
Healthy Volunteers
Not accepted

Interventions

  • Care coordination delivered based on perceived need — BEHAVIORAL
    If patients in intervention group report on the survey that they experience difficulty coordinating care among their providers, the patient will be selected for care management services. Those services will attempt to address the problems with care coordination that the proxy reported.
  • Care coordination delivered based on usual care (e.g. discharge from hospital) — BEHAVIORAL
    If a patient is discharged from a hospital, the patient will be selected for care management services.

Study Details

This pragmatic clinical trial embedded in an accountable care organization will determine the comparative effectiveness of two approaches for assigning care coordinators to older adults at risk for cardiovascular outcomes. The hypothesis is that assigning care coordinators to older adults based on perceived need will be more effective at preventing emergency department visits and hospitalizations compared to usual care.

Key Dates

Start date
May 17, 2023
Status verified
Aug 2025
Primary completion
May 31, 2024
Completion
Jul 11, 2024

Study Design

Enrollment
400 participants (actual)
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH

Arms

  • Experimental: Intervention
    The intervention group will assign care coordinators to individuals based on perceived need for assistance with care coordination. Perceived need will be measured through a proxy's responses to a previously validated telephone survey on perceptions of care coordination.
  • Active Comparator: Control
    Usual care assigns patients to care coordinators in response to a discharge from a hospital or a direct referral from a physician.

Primary Outcome Measure

Number of Emergency Department Visits or Hospital Admissions [ Time Frame: Over 12 months (beginning 1 month after the start of care coordination) ]

Locations (1)

FacilityCityStateZIPSite coordinators
New York Presbyterian Hospital - Weill Cornell MedicineNew YorkNew York10065-

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