Improving Care for Children With Complex Needs (I3CN)
Improving Care for Children With Complex Needs (I3CN) Study
調査の概要
状態
条件
- ケアコーディネーション
- Medically Complex Children
- ケースマネージャー
- Care Manager
- 共同ケア
- 疾病管理
- Patient Care Team or Organization
- Managed Care
- Children With Chronic Conditions
- Children With Special Health Care Needs
- Shared Care Plan
- Patient Care Plan
- Health Care and Resource Utilization
- Adherence to Care
- Functional Status and Productivity
- 健康関連の生活の質
- Satisfaction With Care
- Care Coordinator
- Family Experience of Care
- Quality Health Care
詳細な説明
Children with complex health care needs often lack a comprehensive care plan and access to case management. They are at risk for frequent and prolonged hospitalizations, fragmented care, parental stress/burnout and unsafe care. To address this issue, Seattle Children's Hospital developed the Comprehensive Case Management (CCM) program, which includes access to a special clinic at Seattle Children's with case managers and a health care team that works with parents and community physicians to create care plans for children with complex needs.
The investigators goal is to evaluate whether children who participate in the CCM program have better parent reported access to needed care, timeliness of receiving needed services, more coordinated care, improved health status, and higher parent satisfaction with care compared to children who receive care outside the CCM program. In addition, the investigators will examine whether these children experience decreased annual costs of care, emergency department visits, hospital admissions, and hospital lengths of stay compared to children receiving care outside the program. The investigators also want to understand whether community physicians who have patients enrolled in the CCM program are more satisfied with caring for children with complex medical needs than physicians caring for these children outside the program.
The investigators plan to enroll 650 parents of eligible children into the I3CN study. Three hundred twenty five of these parents will have children enrolled in the CCM program and 325 will have children who continue to receive usual care. Enrolled parents complete a survey every 6 months during the study (5 surveys over 2 ½ years) in order to assess study outcomes including parent perceived. Parent participation in the study will be completed 2 ½ years after enrollment.
When a child enrolls in the CCM program, the child's parent will work together with the CCM team at Seattle Children's to develop a shared care plan for their child. The CCM team includes physicians, nurse practitioners, social workers, nutritionists, and nurse case managers. This plan will include all of the child's routine health care needs in addition to information about what to do when the child gets sick. Community providers will also be asked to review and provide input on the shared care plan. Once the shared care plan is in place, the parent, primary care provider (PCP), and the CCM clinic will follow the standardized processes established by the program and the shared care plan when the child becomes ill.
During the course of the 2 ½ year study, the investigators will analyze our outcomes of interest every 6 months. If the investigators find that children in the CCM the program are experiencing significantly better outcomes than children receiving care outside the program, they will stop the study and open the program to all eligible children.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Washington
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Seattle、Washington、アメリカ、98105
- Seattle Children's Hospital
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- between the ages of 3 months and 18 years,
- have at least three chronic medical conditions requiring active management
- were hospitalized or had an emergency department (ED) visit at SCH within the last year
- their PCP is enrolled in the study
Exclusion Criteria:
- had 2+ visits to Pulmonary, Craniofacial, or Rheumatology within the last year
- had 3+ visits to Nephrology, Gastroenterology and has either Short Gut Syndrome or Crohn's Disease, Endocrinology or Neuromuscular Clinic within the last year
- has had 2+ visits to the Neurodevelopmental clinic and is followed by a NDV doctor
- cancer patient
- transplant recipient
- has cystic fibrosis, muscular dystrophy or sickle cell anemia
- has Down Syndrome and does not have any other medical issues aside from developmental delays
- renal patient on dialysis
- had a hospitalization for > 27 days
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
介入なし:コントロール
いつものケアグループ
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実験的:Comprehensive Care Management Service
Care Coordination through the Comprehensive Care Management Service at Seattle Children's Hospital
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When a child enrolls in the CCM program, the child's parent will work together with the CCM team at Seattle Children's to develop a shared care plan for their child.
This plan will include all of the child's routine health care needs and information about what to do when the child gets sick.
The parent will also have 24 hour access to an on-call CCM nurse.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Cost of Care
時間枠:Baseline, 12 month, 18 month
|
The investigators will examine whether the children in the CCM group experience decreased annual costs of care.
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Baseline, 12 month, 18 month
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Health Care Quality Ranking
時間枠:Baseline, 12-months, 18-months
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For Healthcare Quality Rating, the construct is Parent Satisfaction.
Parents were asked to rate the quality of the health care their child received.
Overall range is 0-100.
Higher values equal a better outcome or more satisfaction.
Sub scales are not combined.
The scale is considered continuous.
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Baseline, 12-months, 18-months
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ED Visits Per Child
時間枠:Baseline, 12-month, 18-month
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Baseline, 12-month, 18-month
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Inpatient Admissions Per Child
時間枠:Baseline, 12 month, 18 month
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Baseline, 12 month, 18 month
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Hospital Days Per Child
時間枠:Baseline, 12-Month, 18-Month
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Number of days each participant stayed in the hospital; assessed from hospital administrative discharge data
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Baseline, 12-Month, 18-Month
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Physician Satisfaction
時間枠:Baseline, 12 Months, 18 months
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Primary care provider (PCP)'s satisfaction with the care coordination program was measured on a scale of 0-100, where the higher number indicates more satisfaction.
This variable was collected at baseline and 12-months but was dropped from the 18 month follow-up as previous analysis suggested it was not relevant to the stated objective.
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Baseline, 12 Months, 18 months
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協力者と研究者
捜査官
- 主任研究者:Rita Mangione-Smith, MD, MPH、Seattle Children's Hospital
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- CCMS
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
ケアコーディネーションの臨床試験
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Washington University School of MedicineColumbia University; Indiana University; Rakai Health Sciences Program; Reach the Youth Uganda積極的、募集していないコントロールアーム_Bolstered Care | 治療アーム_HIVRR+S+FL | 治療アーム_HIVRR+S+FLMウガンダ