Care Coordination in Primary Care Clinical Trial
Official title:
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.
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.
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