Study Design and Participant Characteristics: The CCM Clinical Trial
Background: The fragmented, uncoordinated, and inefficient system of health care delivery in the U.S. fails to meet the needs of aging adults with multiple chronic conditions (multimorbidity). More than half of health care spending for non-institutionalized adults over age 45 is for chronic conditions, and over 80% of Medicare costs can be attributed to beneficiaries with multimorbidity, yet care satisfaction is low, outcomes are sub-optimal and costs are high. Evidence on effective interventions for persons with multimorbidity is limited given that this population is often excluded from clinical trials; however, recent trials provide early evidence that interventions combining health care homes with preventive home visiting strategies improve care delivery and outcomes for adults with multimorbidity. The ability to successfully translate preventive home visiting strategies to aging adults with multimorbidity who are not associated with academic medical centers, live in rural or urban settings, and seek care at Federally Qualified Health Centers (FQHC) is unknown. Testing the effectiveness of these strategies in this diverse setting is urgently needed based on the growth of patients seeking care at FQHCs which is expected to dramatically increase with continued implementation of the Affordable Care Act, the fiscal urgency for higher quality care at lower costs, and the challenge to develop care strategies that allow aging adults to better manage chronic conditions in their own homes and communities.
Methods: Guided by the Chronic Care Model, a single-center, randomized controlled clinical trial is testing the hypothesis that implementing the chronic care management (CCM) intervention with aging adults who have multimorbidity and high acute care utilization will improve patient engagement, health outcomes, and cost-effectiveness. Participants (N=300) are being recruited from a FQHC and then randomized to an attention-control group who receive usual care or the CCM intervention which is collaboratively delivered by a nurse and a social worker.
Results: The poster presentation will describe baseline characteristics of the first 100 enrolled participants, including patient activation measure scores, depressive symptom scores, common health problems identified in the intervention group, and interventions implemented in both the intervention group and attention control group.
Implications: The CCM clinical trial will determine the effectiveness of a patient-centered chronic care intervention, delivered over 12 months, on improving patient activation in self-management and quality of life and in reducing rates and costs of acute care use.