Coventry Outcomes Study of Seniors (COSS): A Comparative Effectiveness Study to Evaluate the Effect of a Multidisciplinary Team’s Intervention on the Incidence of Nonelective Hospitalizations in a Medicare Population

Overview

The investigators are studying the impact of the interventions of a multidisciplinary team (MDT) – consisting of a Coventry case manager, social worker, and medical director, alongside a Medco specialist pharmacist – on the hospitalization rates of high risk seniors with chronic conditions, compared with a usual care approach. The study will also examine the impact on quality of life, medication adherence, medical costs, hospital readmission rates, and a variety of other important measures. The outcome of COSS may support a means to further enhance and develop a comprehensive care model program by leveraging the partnership between a health plan and a pharmacy benefit manager.

Full Title of Study: “Coventry Outcomes Study of Seniors: A Dual-arm, Controlled, Randomized, Comparative Effectiveness Study to Evaluate the Effect of a Multidisciplinary Team’s Intervention Versus Usual Care on the Incidence of Nonelective Hospitalizations in a Medicare Population”

Study Type

  • Study Type: Interventional
  • Study Primary Completion Date: June 2011

Detailed Description

The multidisciplinary team will provide face-to-face visits in a home setting with interventions that focus on five key areas: care transitions, self-management, care coordination, pharmacy and prevention, all designed to support high-risk Medicare members and their relationship with their primary care providers. If the study proves to reduce hospitalizations in the senior population, it could provide important guidance for future efforts to reduce the cost and improve the quality of care for seniors with chronic conditions.

Interventions

  • Other: Multidisciplinary team interventions
    • The multidisciplinary team will determine which intervention should be applied to the participant in the intervention group based on their health risk assessment responses as well as medication review and visual inspection of the home.
  • Other: Multidisciplinary team bimonthly visits either in person or via telephone.
  • Other: Usual case management and pharmacy management as provided by the health Plan and the pharmacy benefit manager

Arms, Groups and Cohorts

  • Other: Control Group
    • The control group will receive usual care as provided by your Health Plan.
  • Other: Intervention group
    • Additional visits will be conducted by a member of the multidisciplinary team (case manager/nurse, social worker and/or pharmacist that will be either face to face or by telephone.

Clinical Trial Outcome Measures

Primary Measures

  • Determine the impact of multidisciplinary team interventions in reducing the rate of non-elective hospitalizations over a 12 month period compared to usual care
    • Time Frame: 12 months

Secondary Measures

  • Determine the impact of multidisciplinary team interventions on the rate of emergency room visits not resulting in hospitalization in a 24 hour period or less.
    • Time Frame: 12 months
  • Determine the impact of multidisciplinary team interventions versus usual care on health-related quality of life (HR-QOL)
    • Time Frame: 12 months
  • Determine the impact of MDT interventions versus usual care on inpatient costs associated with non-elective hospital events [rehabilitation, physician, incurred but not reported (IBNR)]
    • Time Frame: 12 months
  • Determine the impact of multidisciplinary team interventions versus usual care on total outpatient costs (physician, pharmacy,rehabilitation)
    • Time Frame: 12 months
  • Determine the impact of multidisciplinary team interventions versus usual care on satisfaction with care
    • Time Frame: 12 months
  • Determine the impact of multidisciplinary team interventions versus usual care on rate of non-elective hospitalizations by chronic condition
    • Time Frame: 12 months
  • Determine the impact of multidisciplinary team interventions versus usual care on non-elective hospital readmissions at 30, 60, and 90 days following the first non-elective hospitalization event
    • Time Frame: 12
  • Determine the impact of multidisciplinary team interventions versus usual care on the length of stay (LOS) of each non-elective hospitalization
    • Time Frame: 12 months

Participating in This Clinical Trial

Inclusion Criteria

  • Inouye Risk Score >3 calculated on Coventry Claims – Medicare Advantage beneficiaries age > 65 years – Continuous eligibility > 12 months prior to study – Ability to be contacted via telephone – Subject is willing and able to provide informed consent – Willing to comply with all study procedures and be available for the duration of the study Exclusion Criteria:

  • Active cancer treatment (i.e. chemotherapy or radiation) in the past 6 months – Living anywhere other than a community setting [i.e. Skilled nursing facility (SNF)] – Just-In-Time (JIT) Members – Members with a geographic location > 60 from either St. Louis or Kansas City, MO. – Solid organ transplant recipients – Active enrollment in another clinical research study

Gender Eligibility: All

Minimum Age: 65 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Medco Health Solutions, Inc.
  • Collaborator
    • Coventry Health Care, Inc.
  • Provider of Information About this Clinical Study
    • Julia O. McEacherm, Research Director, Medco Health Solutions, Inc.
  • Overall Official(s)
    • Julia O McEachern, MHS, PA-C, Principal Investigator, Medco Health Solutions, Inc.
    • Stephen L Cavalieri, MD, Principal Investigator, Coventry Health Care, Inc.

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