Advertisement

Topics

Video-Enhanced Care Management for Medically Complex Veterans

2016-11-15 11:38:21 | BioPortfolio

Summary

The purpose of this study is to examine the feasibility and acceptability of a 12-week care management program for medically complex Veterans with cognitive impairment, delivered via telephone or videoconferencing.

Description

BACKGROUND Older adults with complex care needs constitute a large and rapidly expanding group of Veterans receiving care within Veterans Health Administration (VHA). Medically complex older Veterans, who often have multiple chronic conditions (MCC) as well as interacting functional and psychosocial challenges, account for a disproportionate amount of health care resources. Importantly, these Veterans also experience a disproportionate amount of suffering; they have worse functional status, higher symptom burden, and spend more of their time in acute care settings such as the hospital and emergency department.

The investigators' experience and recent studies suggest that a substantial proportion of older medically complex Veterans have unrecognized cognitive impairment (CI), and this contributes to their disproportionate need for care and adverse outcomes. The Cumulative Complexity model posits that complexity results from accumulating and interacting clinical and social factors that each contribute to a patient's workload (e.g. making appointments and managing complicated medicine regimens) as well as impact a patient's capacity to perform everyday tasks including those related to health care. Imbalance between the two- i.e. workload that exceeds capacity-is a primary driver of disruptions in care and negative outcomes. Older patients with MCC, high health care utilization, and CI often find themselves in the perfect storm of complexity, simultaneously experiencing escalated workload demands in the setting of reduced capacity.

OBJECTIVES

The primary objectives of this pilot study are to:

Examine the feasibility and acceptability of a 12-week care management program for medically complex Veterans with CI, delivered via telephone or through video visits.

- Feasibility will be examined by calculating overall rates of eligibility and enrollment, as well as rates of attrition, adherence to nurse calls or video visits, and interview completion.

- Acceptability will be assessed using in-depth interviews with study participants (Veterans and Care Partners), primary care providers, and study staff.

Assess the usability and perceived value of video-enhanced care management, compared to telephone-based, among older Veterans with medical complexity and CI.

- Usability of the video-enhanced program will be examined using the System Usability Scale (SUS).

- Perceived value associated with each delivery method will be explored through questionnaires and in-depth interviews with study participants and study staff.

METHODS Veterans aged 65 or older with high medical complexity based on Care Assessment Need (CAN) score will be screened for CI using a reliable and valid instrument developed for use over the telephone. Veterans with CI, and a self-identified Care Partner, will participate in a nurse-led care management program designed to provide structured cognitively-appropriate information and support in two key areas: (1) care coordination (reduce workload) and (2) protecting cognitive health (build capacity). Evidence-based strategies to improve care coordination and promote cognitive health are enhanced by video visits that allow for improved communication between the nurse and Veteran/Care Partner, and facilitate expanded assessments of the Veteran and his/her home environment. Study measures will include the SUS, participant feedback, and measures of intervention effectiveness including health and physical function (PROMIS 29), physical activity levels (PASE), depression (PHQ-9), anxiety (GAD-7), and acute care days (hospital and ER).

ANTICIPATED IMPACT Results from this preliminary study will be used to inform the development of a randomized clinical trial to evaluate the impact of a 12-month video-enhanced care management program for medically complex older adults with CI. Given the large number of medically complex Veterans affected by unrecognized CI, it is essential that interventions targeting this population be scalable, and technology-enhanced interventions offer a way to expand the reach of new care models. Proactive recognition and management of medically complex patients is a high priority for VHA, and medically complex Veterans with CI constitute one such high risk group. The results of this study will be of high relevance to VHA, and outside VA, given the urgent need to develop innovative means of improving care for medically complex older adults.

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Conditions

Multimorbidity

Intervention

Care management via videoconference, Care management via telephone calls

Location

Durham VA Medical Center, Durham, NC
Durham
North Carolina
United States
27705

Status

Not yet recruiting

Source

VA Office of Research and Development

Results (where available)

View Results

Links

Published on BioPortfolio: 2016-11-15T11:38:21-0500

Clinical Trials [7271 Associated Clinical Trials listed on BioPortfolio]

Improving Insulin Therapy With Enhanced Care Management

VA diabetes patients often have difficulty managing their self-care and accessing clinic-based services; many also lack social support to help them meet the demands of their illness. Enhan...

Automated Calls With Nurse Follow-Up to Improve Diabetes Ambulatory Care

Regular outpatient follow-up is important for all diabetes patients, with some needing frequent attention because their health is unstable, their treatment regimen is complex, or their soc...

Culturally Sensitive Depression Care Management for Latino Primary Care Patients

The purpose of this study is to determine whether telephonic depression care management can improve depression outcomes for Latino primary care patients who are enrolled in Medicaid and ar...

Telephone-Based Care Management Program for Individuals With Anxiety Disorders

This study will determine the impact of a telephone-based care management program for primary care patients with panic disorder or generalized anxiety disorder.

Telephone Disease Management At-Risk Drinking (TDM II)

The aim of this study is to test for improvements in treatment outcomes for primary care patients with at-risk drinking when cared for using telephone disease management (TDM) compared to ...

PubMed Articles [20114 Associated PubMed Articles listed on BioPortfolio]

Telephone-based management of chronic pain in older adults in an integrated care program.

Few studies have explored behavioral strategies for managing chronic pain in older adults. Pain Care Management (PCM) is a telephone-based behavioral intervention for chronic pain. The present study e...

Patients' perspectives of care management: a qualitative study.

Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients' perspectives of care management are scarce. We explored patients' experiences with ca...

Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care.

A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health managemen...

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi.

The high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in ho...

Review of Transitional Care Management and Chronic Care Management Codes for Pulmonologists.

Patients with advanced respiratory illness are often hospitalized, requiring close follow up after discharge and also requiring care coordination outside of traditional face-to-face outpatient visits....

Medical and Biotech [MESH] Definitions

Assistants to a veterinarian, biological or biomedical researcher, or other scientist who are engaged in the care and management of animals, and who are trained in basic principles of animal life processes and routine laboratory and animal health care procedures. (Facts on File Dictionary of Health Care Management, 1988)

Management control systems for structuring health care delivery strategies around case types, as in DRGs, or specific clinical services.

Voluntarily-formed groups of healthcare professionals who join for common management services and other benefits such as collective bargaining agreements with reimbursement agents. The physical assets of a practice are controlled by the MSO which also provides billing, collections, and similar services. The practitioner retains control of patient records and management of patient care.

A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)

Generating, planning, organizing, and administering medical and nursing care and services for patients.

More From BioPortfolio on "Video-Enhanced Care Management for Medically Complex Veterans"

Advertisement
Quick Search
Advertisement
Advertisement

 

Searches Linking to this Trial