The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale
Abstract Background Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinica...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2018-12-01
|
Series: | Addiction Science & Clinical Practice |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13722-018-0128-y |
id |
doaj-ed8a73107e814c6fb40f9996d96b8184 |
---|---|
record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Brian Chan Samuel T. Edwards Meg Devoe Richard Gil Matthew Mitchell Honora Englander Christina Nicolaidis Devan Kansagara Somnath Saha P. Todd Korthuis |
spellingShingle |
Brian Chan Samuel T. Edwards Meg Devoe Richard Gil Matthew Mitchell Honora Englander Christina Nicolaidis Devan Kansagara Somnath Saha P. Todd Korthuis The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale Addiction Science & Clinical Practice Primary care innovation Health service delivery Patient experience Patient centered medical home Partnered-research Complex care |
author_facet |
Brian Chan Samuel T. Edwards Meg Devoe Richard Gil Matthew Mitchell Honora Englander Christina Nicolaidis Devan Kansagara Somnath Saha P. Todd Korthuis |
author_sort |
Brian Chan |
title |
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
title_short |
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
title_full |
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
title_fullStr |
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
title_full_unstemmed |
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
title_sort |
summit ambulatory-icu primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale |
publisher |
BMC |
series |
Addiction Science & Clinical Practice |
issn |
1940-0640 |
publishDate |
2018-12-01 |
description |
Abstract Background Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research. Methods/design Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or who have substance use disorders. Participants meet at least one of the following criteria: > 1 hospitalization over past 6 months; at least one medical co-morbidity including uncontrolled diabetes, heart failure, chronic obstructive pulmonary disease, liver disease, soft-tissue infection; and 1 mental health diagnosis or substance use disorder. We exclude patients if they have < 6 months to live, have cognitive impairment preventing consent, or are non-English speaking. Following consent and baseline assessment, we randomize participants to immediate SUMMIT intervention or wait-list control group. Participants receiving the SUMMIT intervention transfer care to a clinic-based team of physician, complex care nurse, care coordinator, social worker, and pharmacist with reduced panel size and flexible scheduling with emphasis on motivational interviewing, patient goal setting and advanced care planning. Wait-listed participants continue usual care plus engagement with community health worker intervention for 6 months prior to joining SUMMIT. The primary outcome is hospital utilization at 6 months; secondary outcomes include emergency department utilization, patient activation, and patient experience measures. We follow participants for 12 months after intervention initiation. Discussion The SUMMIT A-ICU is an intensive primary care intervention for high-utilizers impacted by homelessness. Use of a wait-list control design balances community and staff stakeholder needs, who felt all participants should have access to the intervention, while addressing research needs to include control populations. Design limitations include prolonged follow-up period that increases risk for attrition, and conflict between practice and research; including partner stakeholders and embedded researchers familiar with the population in study planning can mitigate these barriers. Trial registration ClinicalTrials.gov NCT03224858, Registered 7/21/17 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03224858 |
topic |
Primary care innovation Health service delivery Patient experience Patient centered medical home Partnered-research Complex care |
url |
http://link.springer.com/article/10.1186/s13722-018-0128-y |
work_keys_str_mv |
AT brianchan thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT samueltedwards thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT megdevoe thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT richardgil thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT matthewmitchell thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT honoraenglander thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT christinanicolaidis thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT devankansagara thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT somnathsaha thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT ptoddkorthuis thesummitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT brianchan summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT samueltedwards summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT megdevoe summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT richardgil summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT matthewmitchell summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT honoraenglander summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT christinanicolaidis summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT devankansagara summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT somnathsaha summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale AT ptoddkorthuis summitambulatoryicuprimarycaremodelformedicallyandsociallycomplexpatientsinanurbanfederallyqualifiedhealthcenterstudydesignandrationale |
_version_ |
1724957176883052544 |
spelling |
doaj-ed8a73107e814c6fb40f9996d96b81842020-11-25T02:01:24ZengBMCAddiction Science & Clinical Practice1940-06402018-12-0113111110.1186/s13722-018-0128-yThe SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationaleBrian Chan0Samuel T. Edwards1Meg Devoe2Richard Gil3Matthew Mitchell4Honora Englander5Christina Nicolaidis6Devan Kansagara7Somnath Saha8P. Todd Korthuis9Division of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityCentral City ConcernCentral City ConcernDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityDivision of General Internal Medicine and Geriatrics, Oregon Health and Science UniversityAbstract Background Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research. Methods/design Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or who have substance use disorders. Participants meet at least one of the following criteria: > 1 hospitalization over past 6 months; at least one medical co-morbidity including uncontrolled diabetes, heart failure, chronic obstructive pulmonary disease, liver disease, soft-tissue infection; and 1 mental health diagnosis or substance use disorder. We exclude patients if they have < 6 months to live, have cognitive impairment preventing consent, or are non-English speaking. Following consent and baseline assessment, we randomize participants to immediate SUMMIT intervention or wait-list control group. Participants receiving the SUMMIT intervention transfer care to a clinic-based team of physician, complex care nurse, care coordinator, social worker, and pharmacist with reduced panel size and flexible scheduling with emphasis on motivational interviewing, patient goal setting and advanced care planning. Wait-listed participants continue usual care plus engagement with community health worker intervention for 6 months prior to joining SUMMIT. The primary outcome is hospital utilization at 6 months; secondary outcomes include emergency department utilization, patient activation, and patient experience measures. We follow participants for 12 months after intervention initiation. Discussion The SUMMIT A-ICU is an intensive primary care intervention for high-utilizers impacted by homelessness. Use of a wait-list control design balances community and staff stakeholder needs, who felt all participants should have access to the intervention, while addressing research needs to include control populations. Design limitations include prolonged follow-up period that increases risk for attrition, and conflict between practice and research; including partner stakeholders and embedded researchers familiar with the population in study planning can mitigate these barriers. Trial registration ClinicalTrials.gov NCT03224858, Registered 7/21/17 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT03224858http://link.springer.com/article/10.1186/s13722-018-0128-yPrimary care innovationHealth service deliveryPatient experiencePatient centered medical homePartnered-researchComplex care |