Preventing Tipping Points in High Comorbidity Patients: A Lifeline From Health Coaches

NCT ID: NCT04176510

Last Updated: 2023-02-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1920 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-20

Study Completion Date

2025-12-01

Brief Summary

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This pragmatic cluster randomized clinical trial (cRCT) aims to evaluate the comparative effectiveness (CER) of two approaches to preventing destabilization ("tipping points") that lead to unplanned hospitalization and increased disability. The cRCT compares the outcomes of patients randomized in clusters by site within four Federally Qualified Health Center (FQHC) networks in New York City (NYC) and Chicago to either: 1) the Patient Centered Medical Home (PCMH); or 2) the Patient Centered Home plus a health coaching intervention that employs a positive affect/self-affirmation intervention to help motivate patients to succeed at implementing self-management by setting life goals (experimental).

This RCT embeds novel effective interventions within large FQHC networks, namely, Community Healthcare Network and the Family Health Centers of New York University (NYU) Langone in NYC and Erie Family Health Centers and Friend Family Health Center in Chicago, serving patients with multiple chronic diseases or high comorbidity. This CER study compares two PCMH-based strategies and will provide a manualized training system that can be disseminated and implemented across the national FQHC networks, with over 9,000 delivery sites that serve nearly 25 million low-income and minority patients, and can be implemented in a wider range of practice settings, organization types and population characteristics.

Among 1920 adult patients with a Charlson Comorbidity Index ≥4 who are established primary care patients of 16 Federally Qualified Health Centers (FQHCs) in NYC (8 FQHCs) and Chicago (8 FQHCs) this pragmatic cRCT aims to evaluate the effectiveness of two approaches to preventing destabilization that leads to unplanned hospitalization and increased disability.

This Patient-Centered Outcomes Research Institute (PCORI) study builds on the National Patient-Centered Clinical Research Network (PCORnet) Clinical Data Research Networks (CDRNs) in NYC and Chicago. Patients will be identified via electronic health records (EHRs) and their outcomes assessed through comprehensive, longitudinal, electronic health records that are aggregated by these PCORnet CDRNs.

Detailed Description

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Conditions

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Comorbidity Self-Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Patient Centered Medical Home (PCMH) plus Health Coach

A health coaching intervention that employs a positive affect/self-affirmation intervention to help motivate patients to succeed at implementing self-management by setting life goals, in addition to the usual care provided for patients with multiple chronic diseases by the The Patient-Centered Medical Home (PCMH).

Group Type EXPERIMENTAL

Health Coach Intervention

Intervention Type BEHAVIORAL

A structured, manualized coaching intervention by a lay Health Coach that employs a standardized positive affect/self-affirmation intervention, not tied to specific chronic diseases, to help motivate patients to learn to implement self-management by setting life goals.

Patient Centered Medical Home (PCMH)

Usual care provided for patients with multiple chronic diseases by the Patient-Centered Medical Home (PCMH).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Health Coach Intervention

A structured, manualized coaching intervention by a lay Health Coach that employs a standardized positive affect/self-affirmation intervention, not tied to specific chronic diseases, to help motivate patients to learn to implement self-management by setting life goals.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Established patients of the participating Federally Qualified Health Centers (FHQCs)
* Charlson comorbidity index ≥4

Exclusion Criteria

* Metastatic cancer,
* End stage renal disease on dialysis
* Post-transplant
* Severe mental illness
* Drug/alcohol abuse
* Cannot communicate in English or Spanish.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

Clinical Directors Network

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jonathan N Tobin, PhD

Role: PRINCIPAL_INVESTIGATOR

Clinical Directors Network

Mary Charlson, MD

Role: PRINCIPAL_INVESTIGATOR

Weill Medical College of Cornell University

Andrea Cassells, MPH

Role: STUDY_DIRECTOR

Clinical Directors Network

Anisa Mian, MPH

Role: STUDY_DIRECTOR

Clinical Directors Network

Locations

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Friend Health, Inc.

Chicago, Illinois, United States

Site Status RECRUITING

Erie Family Health Centers

Chicago, Illinois, United States

Site Status RECRUITING

Family Health Centers at NYU Langone

Brooklyn, New York, United States

Site Status RECRUITING

Community Healthcare Network

New York, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Anisa Mian, MPH

Role: CONTACT

2123820699 ext. 254

TJ Lin, MPH

Role: CONTACT

2123820699 ext. 225

Facility Contacts

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Biswas Pradhan

Role: primary

Paula Rusca

Role: primary

Radhika Gore, PhD

Role: primary

Christine Rutkoski

Role: primary

References

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Charlson ME, Mittleman I, Ramos R, Cassells A, Lin TJ, Eggleston A, Wells MT, Hollenberg J, Pirraglia P, Winston G, Tobin JN. Preventing "tipping points" in high comorbidity patients: A lifeline from health coaches - rationale, design and methods. Contemp Clin Trials. 2025 May;152:107865. doi: 10.1016/j.cct.2025.107865. Epub 2025 Feb 28.

Reference Type DERIVED
PMID: 40024364 (View on PubMed)

Other Identifiers

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8923

Identifier Type: OTHER

Identifier Source: secondary_id

IHS-2017C3-8923

Identifier Type: -

Identifier Source: org_study_id

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