Computer Assisted Symptom Evaluation of Complex Patients (CASE)

Computer Assisted Quality of Life and Symptom Assessment of Complex Patients

Patients who have advanced or multiple chronic illnesses present management difficulties for primary care providers. Acute medical issues and limited time for patient evaluation can complicate complete assessment of physical symptoms that directly impact a patient's quality of life. The Cook County Health and Hospitals System (CCHHS) established an Advanced Illness Management Clinic to provide care for complex patients. Patient entry into the Advanced Illness Management Clinic is by referral only, a passive process. After discharge, general medicine clinic patients who do not have a medical provider are given an appointment in the clinic. Since the hospital is the source of many patients, this guarantees that these patients will have at least one illness advanced enough to require hospitalization, and most will have additional chronic illnesses. An outpatient palliative care clinic located in a specialty clinic setting was initiated in 2004. The goal of the clinic was to extend the benefits realized by hospital patients, for whom palliative care consultation has been available for many years, to patients cared for in the outpatient setting. The benefits provided include physical symptom management, spiritual counseling, and support for social issues. Until recently, this outpatient palliative care model has mainly served patients with malignancy. With the addition of the Advanced Illness Management Clinic, palliative care clinicians now can provide care to patients with other chronic and serious illness in the primary care setting.

Hypothesis: Complex patients will have improved quality of life and a reduced symptom burden if seen by a multidisciplinary clinic post-hospitalization, compared to usual care in a general medicine clinic.

Study Overview

• Status: Completed
• Conditions: Multiple Co-morbidities
• Intervention / Treatment: Behavioral: Enhanced patient-centered care

Detailed Description

Outcome measures:

1. Quality of life as measured by the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) short form
2. Physical symptom burden as measured by the Memorial Symptom Assessment Scale (MSAS), short form

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Stroger Hospital of Cook County

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• English or Spanish speaker
• Must be a general medicine clinic patient
• Must have a physical symptom score on MSAS above threshold (i.e., 1.0 or higher)
• Must have a phone number for contact

Exclusion Criteria:

• Visual or cognitive impairment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Enhanced patient-centered care; Patients will be evaluated and treated in the advanced illness management clinic	Behavioral: Enhanced patient-centered care; The experimental arm will be referred to a multi-disciplinary clinic
No Intervention: Usual care; Patients will receive usual care by their primary care physicians without automated referral to specialized providers.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NIH PROMIS 10-item short form quality of life	We will assess the physical and mental components of the quality of life instrument	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
MSAS physical symptom score		6 months
Healthcare utilization	We will monitor healthcare utilization within our system. To include visits to the emergency room, clinics, and hospitalizations.	6 months

Collaborators and Investigators

• Sponsor: Cook County Health
• Collaborators: Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: William E Trick, MD, Cook County Health & Hospitals System

Study record dates

Study Major Dates

• Study Start: June 1, 2011
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: July 7, 2011
• First Submitted That Met QC Criteria: July 7, 2011
• First Posted (Estimated): July 11, 2011

Study Record Updates

• Last Update Posted (Actual): June 22, 2023
• Last Update Submitted That Met QC Criteria: June 19, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Keywords: Medical informatics; Health services accessibility
• Other Study ID Numbers: 10-143; 1R24HS019481-01 (U.S. AHRQ Grant/Contract)