Feasibility of Care Coordination

Feasibility of Care Coordination in an Integrative Primary Care Concierge Practice

The primary aim of this study is to determine feasibility of incorporating a primary care coordinator (PCC) into an integrative concierge primary care practice. Secondary aims include:

1. To determine whether the PCC intervention increases patient satisfaction and/or patient activation.
2. To determine whether regular telephone contacts from a PCC over a period of 6 months increases the number of visits and services by DIPC members.

Study Overview

• Status: Completed
• Conditions: Care Coordination in Primary Care
• Intervention / Treatment: Behavioral: Primary care coordination

Detailed Description

The Duke Integrative Primary Care (DIPC) clinic in Durham, North Carolina currently serves over 600 patients, and offers a full range of primary care services. The practice is a fee-based model where patients pay a monthly fee to access primary care services, and includes several membership benefits. These benefits include longer appointment times, visits with physicians trained in integrative medicine, access to the Duke Health and Fitness Center, on-site discounts, and use of facilities at Duke Integrative Medicine.

Preliminary information gathered show that DIPC members state reasons of value, cost and underutilization for cancelling their memberships. Underutilized primary care memberships may represent missed opportunities to increase patient satisfaction, improve patient outcomes, and maximize clinic revenue.

DIPC employs an administrative coordinator responsible for assisting patients with enrolling and renewing their primary care memberships, but to date, there has not been a clinical care coordinator role in the DIPC clinic.

This study will provide the basis for understanding the feasibility of incorporating care coordination into the Duke Integrative Primary Care practice. In addition, cost and effort of the care coordinator will be compared to additional volume, revenue and patient satisfaction data to increase understanding of the value proposition. Further, information gathered during this study could suggest possible impact on membership retention rates, as well as inform next steps for continuous improvement initiatives for the integrative primary care practice.

Primary aim: To determine feasibility of incorporating a PCC into an integrative concierge primary care practice.

Secondary aims:

1. To determine whether the PCC intervention increases patient satisfaction and/or patient activation.
2. To determine whether regular telephone contacts from a PCC over a period of 6 months increases the number of visits and services by DIPC members.

After each subject completes an online consent and a pre-intervention questionnaire housed in a REDCap database, the PCC intervention will begin for that subject. A registered nurse currently employed at Duke Integrative Medicine, who is also trained as an integrative health coach, will serve in the PCC role. The intervention will flow as follows:

The PCC will call study participants every 2 months during the 6 months (more frequently as needed) for a semi-structured phone check-in, and will track the intervention through the REDCap database. The PCC will use guiding questions to frame the call, but will also:

Respond Ask follow-up questions Provide suggestions that are guided by the patient response and appropriateness to the individual situation and needs and scope of practice.

Prior to the call, the PCC will review the patient chart to see if any outstanding orders, medical visits due, and review the patient health goals (known as the "pre-work").

The PCC will call the patient to provide intervention. If patient is not available, the PCC will leave a message, or contact via MyChart to see about scheduling a time to talk.

After the 6-month intervention is complete, the study coordinator will send each individual subject a link to the post-intervention questionnaire in REDCap, and will follow up with each subject to ensure completion of this questionnaire.

• Study Type: Interventional
• Enrollment (Actual): 31
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Duke Integrative Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Member of the Duke Integrative Primary Care clinic in Durham, NC who have been members for at least 1 year.

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Primary care coordination

Behavioral: Primary care coordination; A registered nurse currently employed at Duke Integrative Medicine, who is also trained as an integrative health coach, will serve in the PCC role. The intervention will flow as follows: The PCC will call study participants every 2 months during the 6 months (more frequently as needed) for a semi-structured phone check-in, and will track the intervention through the REDCap database. The PCC will use guiding questions to frame the call, but will also: Respond Ask follow-up questions Provide suggestions that are guided by the patient response and appropriateness to the individual situation and needs and scope of practice. Prior to the call, the PCC will review the patient chart to see if any outstanding orders, medical visits due, and review the patient health goals (known as the "pre-work"). The PCC will call the patient to provide intervention. If patient is not available, the PCC will leave a message, or contact via MyChart to see about scheduling a time to talk.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of patients enrolled	Number of patients enrolled as measured by enrollment logs	6 months
Number of patients that completed minimum intervention	Number of patients that completed a minimum of 3 intervention calls as measured by call logs	Up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient satisfaction	Number of patients that stated they were satisfied as measured by an internally-designed questionnaire	Up to 1 year
Number of additional clinic visits	Number of additional clinic visits as determined by visits scheduled due to referrals that happened within the intervention	Up to 1 year

Collaborators and Investigators

• Sponsor: Duke University

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 14, 2018
• Primary Completion (ACTUAL): October 11, 2018
• Study Completion (ACTUAL): April 11, 2019

Study Registration Dates

• First Submitted: November 19, 2019
• First Submitted That Met QC Criteria: November 19, 2019
• First Posted (ACTUAL): November 21, 2019

Study Record Updates

• Last Update Posted (ACTUAL): November 21, 2019
• Last Update Submitted That Met QC Criteria: November 19, 2019
• Last Verified: November 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: Pro00087885

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No