Computer Assisted Symptom Evaluation of Complex Patients (CASE)

Cook County Health

Status: Completed

Conditions: Multiple Co-morbidities

Treatments: Behavioral: Enhanced patient-centered care

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT01391026

10-143

1R24HS019481-01 (U.S. AHRQ Grant/Contract)

Details and patient eligibility

About

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.

Full 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

Enrollment: 200 patients

Sex: All

Ages: 18 to 110 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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200 participants in 2 patient groups

Usual care

No Intervention group

Description:

Patients will receive usual care by their primary care physicians without automated referral to specialized providers.

Enhanced patient-centered care

Experimental group

Description:

Patients will be evaluated and treated in the advanced illness management clinic

Treatment:

Behavioral: Enhanced patient-centered care