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

Emergencies Clinical Trial

Official title:

Impact of a Novel Complex Outpatient Clinic Setup on Patient Outcomes and Intern Education

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT04375189
• Other study ID #: IRB00137125
• Status: Withdrawn
• Phase: N/A
• Start date: July 1, 2016
• Est. completion date: July 20, 2022

Study information

• Verified date: July 2022
• Source: Johns Hopkins University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: July 20, 2022
• Est. primary completion date: July 1, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Comorbidities and Coexisting Conditions
• Emergencies
• Risk Reduction

Intervention

Other:
• High Risk Clinic
Subgroup of primary care clinic where patients have longer time slots, supervision by one longitudinal attending, "bedside" presentations

Locations

Country	Name	City	State
United States	Johns Hopkins Outpatient Center	Baltimore	Maryland

Sponsors (1)

Lead Sponsor	Collaborator
Johns Hopkins University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Inpatient or ER visits	Presentations to the ER and hospitalizations	Up to 2 years post enrollment
Secondary	Total medical cost	Total medical costs (Outpatient, Inpatient, Imaging, Labs)	Up to 2 years post enrollment