Medical Assistant–Based Care Management for High-Risk Patients in Small Primary Care Practices

• DOI: 10.7326/m14-2403
• Publication Date: 2016-02-02T02:32:50Z
• Authors: Tobias Freund; Frank Peters-Klimm; Cynthia M. Boyd; Cornelia Mahler; Jochen Gensichen; Antje Erler; Martin Beyer; Matthias Gondan; Justine Rochon; Ferdinand M. Gerlach; Joachim Szecsenyi
• Keywords: Quartile; Medical record

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