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

NCT ID: NCT04375189

Last Updated: 2022-07-25

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-07-01
• Study Completion Date: 2022-07-20

Brief 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.

Conditions

Comorbidities and Coexisting Conditions; Risk Reduction; Emergencies

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

Standard Care

Group Type: NO_INTERVENTION

No interventions assigned to this group

Complex Clinic Arm

Group Type: EXPERIMENTAL

High Risk Clinic

Intervention Type: OTHER

Subgroup of primary care clinic where patients have longer time slots, supervision by one longitudinal attending, "bedside" presentations

Interventions

High Risk Clinic

Subgroup of primary care clinic where patients have longer time slots, supervision by one longitudinal attending, "bedside" presentations

Intervention Type: OTHER

Eligibility Criteria

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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Johns Hopkins University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Jeremy Epstein

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins University

Locations

Johns Hopkins Outpatient Center

Baltimore, Maryland, United States

Countries

United States

Other Identifiers

IRB00137125

Identifier Type: -

Identifier Source: org_study_id