Medical assistant-based care management for high-risk patients in small primary care practices

A cluster randomized clinical trial

Tobias Freund, Frank Peters-Klimm, Cynthia Boyd, Cornelia Mahler, Jochen Gensichen, Antje Erler, Martin Beyer, Matthias Gondan, Justine Rochon, Ferdinand M. Gerlach, Joachim Szecsenyi

Research output: Contribution to journalArticle

Abstract

Background: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective: To determine whether protocol-based care management delivered by medical assistants improves care in patients at high risk for future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508) Setting: 115 primary care practices in Germany. Patients: 2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data. Intervention: Protocol-based care management, including structured assessment, action planning, and monitoring delivered by medical assistants, compared with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]). Results: Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month. Limitation: Small number of primary care practices and low intensity of intervention. Conclusion: This low-intensity intervention did not reduce allcause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients.

Original languageEnglish (US)
Pages (from-to)323-330
Number of pages8
JournalAnnals of Internal Medicine
Volume164
Issue number5
DOIs
StatePublished - Mar 1 2016

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Risk Management
Primary Health Care
Hospitalization
Randomized Controlled Trials
Quality of Life
Patient Care
Odds Ratio
Costs and Cost Analysis
Self Care
Health Surveys
Insurance
Chronic Obstructive Pulmonary Disease
Type 2 Diabetes Mellitus
Germany
Heart Failure
Health
Population

ASJC Scopus subject areas

  • Internal Medicine

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Medical assistant-based care management for high-risk patients in small primary care practices : A cluster randomized clinical trial. / Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia; Mahler, Cornelia; Gensichen, Jochen; Erler, Antje; Beyer, Martin; Gondan, Matthias; Rochon, Justine; Gerlach, Ferdinand M.; Szecsenyi, Joachim.

In: Annals of Internal Medicine, Vol. 164, No. 5, 01.03.2016, p. 323-330.

Research output: Contribution to journalArticle

Freund, T, Peters-Klimm, F, Boyd, C, Mahler, C, Gensichen, J, Erler, A, Beyer, M, Gondan, M, Rochon, J, Gerlach, FM & Szecsenyi, J 2016, 'Medical assistant-based care management for high-risk patients in small primary care practices: A cluster randomized clinical trial', Annals of Internal Medicine, vol. 164, no. 5, pp. 323-330. https://doi.org/10.7326/M14-2403
Freund, Tobias ; Peters-Klimm, Frank ; Boyd, Cynthia ; Mahler, Cornelia ; Gensichen, Jochen ; Erler, Antje ; Beyer, Martin ; Gondan, Matthias ; Rochon, Justine ; Gerlach, Ferdinand M. ; Szecsenyi, Joachim. / Medical assistant-based care management for high-risk patients in small primary care practices : A cluster randomized clinical trial. In: Annals of Internal Medicine. 2016 ; Vol. 164, No. 5. pp. 323-330.
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AU - Gensichen, Jochen

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AU - Beyer, Martin

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