Improving How People Living With Dementia Are Selected for Care Coordination

Dementia Clinical Trial

Official title:

Improving How People Living With Dementia Are Selected for Care Coordination: A Pragmatic Clinical Trial Embedded in an Accountable Care Organization

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05651308
• Other study ID #: 22-10025292
• Secondary ID: 3U54AG063546-03S
• Status: Completed
• Phase: N/A
• Start date: December 5, 2022
• Est. completion date: March 31, 2024

Study information

• Verified date: May 2024
• Source: Weill Medical College of Cornell University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Many people living with dementia (PLWD) and their care partners may benefit from the assistance of a care coordinator, a member of the medical team who facilitates communication among all the people involved. However, care coordinators' time is limited, and there is uncertainty about which patients should be selected to receive their help. This pragmatic clinical trial embedded in an accountable care organization will determine the comparative effectiveness of two approaches for assigning care coordinators to PLWD.

Description:

This project will use a pragmatic clinical trial embedded in an accountable care organization (ACO) to determine the comparative effectiveness of two different approaches for selecting PLWD to receive support from care coordinators: (1) an approach that assigns PLWD to care coordinators based on care partners' self-reported difficulty with care coordination, or (2) usual care, which generally assigns PLWD to care coordinators after hospital discharge, regardless of perceived need. The investigators will include community-dwelling Medicare beneficiaries ≥65 years old with dementia who have been attributed to the NewYork Quality Care ACO and who have fragmented care. The investigators will randomize the participants into two groups. This study is highly pragmatic, and the intervention is sustainable and scalable. Moreover, the proposed approach has the potential to improve care delivery and outcomes for PLWD.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 385
• Est. completion date: March 31, 2024
• Est. primary completion date: March 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 65 Years and older

Eligibility

Inclusion Criteria:

• Medicare beneficiaries =65 years old who:

• Are attributed to the NewYork Quality Care accountable care organization by Medicare,

• Have dementia (as measured in claims using the Bynum standard 1-year definition),

• Reside in the community, and

• Had fragmented ambulatory care in the previous 12 months (defined as a reversed Bice-Boxerman Index greater than or equal to the median score for this population, using Medicare claims)

Exclusion Criteria:

• Those who reside in long-term care or nursing home facilities (based on addresses in Medicare claims), or

• Enrolled in home hospice

Related Conditions & MeSH terms

• Dementia

Intervention

Behavioral:
• Care coordination delivered based on perceived need
If proxies for patients in intervention group report on the survey that they experience difficulty coordinating care among the patients' providers, the patient will be selected for care management services. Those services will attempt to address the problems with care coordination that the proxy reported.
• Care coordination delivered based on usual care (e.g. discharge from hospital)
If a patient is discharged from a hospital, the patient will be selected for care management services.

Locations

Country	Name	City	State
United States	New York Presbyterian Hospital - Weill Cornell Medicine	New York	New York

Sponsors (3)

Lead Sponsor	Collaborator
Weill Medical College of Cornell University	Brown University, National Institute on Aging (NIA)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of emergency department visits or hospital admissions	Occurrence of an emergency department visit or hospital admission, as measured in Medicare claims	Over 12 months (beginning 1 month after the start of care coordination)
Secondary	Acceptability, as measured by the proportion of participants who are engaged with care	Participants are considered engaged with care if they agree to receive care coordination	Up to 1 year
Secondary	Appropriateness, as measured by the proportion of problems with communication that are identified by participants and that are in scope for the work of care coordinators	The proportion of problems identified that are in scope for the work of care coordinators	Up to 1 year
Secondary	Fidelity, as measured by the proportion of eligible individuals who receive care coordination services	The proportion of eligible individuals who receive care coordination services	Up to 1 year
Secondary	Efficiency, as measured by the total number of care-coordinator hours used	The total number of care-coordinator hours used in each study group	Up to 1 year