High Risk Outpatient Intern-led Care (HeROIC) Clinic Initiative

Johns Hopkins University

Status: Withdrawn

Conditions: Emergencies; Risk Reduction; Comorbidities and Coexisting Conditions

Treatments: Other: High Risk Clinic

Study type: Interventional

Funder types: Other

Identifiers

NCT04375189

IRB00137125

Details and patient eligibility

About

Background: A small subset of the patient population is responsible for a significant proportion of healthcare expenditures. These patients are cared for in academic medical centers by internal medicine residents however there has been no research to date about the education or the management of patients with complex multimorbidity in the outpatient setting.

Objective: To evaluate the impact of the High Risk Outpatient Intern-led Care (HeROIC) Clinic on internal medicine interns' perceived ability to manage complex outpatients as well as pre and post intervention total patient healthcare cost.

Methods: The investigators created the HeROIC outpatient clinic environment to comprise longer visit time slots, "bedside" presentations, and team-based care (one intern primary care provider, one secondary intern, and one longitudinal attending). All non-preliminary interns based at one primary care site participated in the intervention while interns at a second site continued to practice in the usual outpatient clinic environment. The interns in the HeROIC clinic arm assumed the roles of primary care providers for 34 complex patients in total. The primary outcome was the perceived confidence in the management of complex outpatients as assessed by a survey. Secondary outcomes included perceptions about the ability to provide high-quality outpatient and evidence-based outpatient care, as well as statewide pre-post patient healthcare cost data.

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ≥ 6 medical comorbidities
• ≥ 2 admissions past 6 months or ≥ 4 past 1 year
• New or returning patient in resident primary care clinic

Exclusion criteria

• Primary mental health disease driving hospitalizations

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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0 participants in 2 patient groups

Standard Care

No Intervention group

Complex Clinic Arm

Experimental group

Treatment:

Other: High Risk Clinic