Ignite Creation Date:
2024-05-06 @ 6:55 PM
Last Modification Date:
2024-10-26 @ 2:57 PM
Study NCT ID:
NCT05829642
Status:
COMPLETED
Last Update Posted:
2023-08-15
First Post:
2023-02-15
Brief Title:
Estonias Enhanced Care Management Impact Evaluation
Sponsor:
Harvard School of Public Health HSPH
Organization:
Harvard School of Public Health HSPH
Study Overview
Official Title:
Evaluating the Rollout of Estonias Enhanced Care Management Program
Status:
COMPLETED
Status Verified Date:
2023-08
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
ECM
Brief Summary:
Estonias aging population faces an increasing burden of non-communicable diseases NCDs and a growing population suffers with multiple chronic conditions These changes have reduced well-being and quality of life for many older Estonians while increasing the use of high cost specialist and emergency care In response the Estonia Health Insurance Fund EHIF is working to support primary care physicians to improve care for complex patients with multiple chronic conditions A new EHIF-led program Enhanced Care Management ECM entails training family physicians to identify complex patients co-develop proactive care plans with them and to undertake more active outreach to and management of these patients
Detailed Description:
The Enhanced Care Management ECM intervention consists of training and coaching family physicians and their teams to develop holistic care and pro-active outreach plans for chronically ill patients or those vulnerable to developing chronically illnesses as identified and agreed between the enrolled providers and the Estonian Health Insurance Fund EHIF Under ECM patients covered by EHIF and suffering from chronic diseases such as diabetes and cardiovascular diseases will be proactively engaged and monitored by primary care providers to provide better care and to prevent health deterioration
Risk-stratified care management for chronic conditions was first introduced in Estonia in 2017 to better support high-risk patients with an assortment of chronic conditions and an increased risk of healthcare utilization The Enhanced Care Management ECM program is intended to improve the quality of care provided to complex patients with qualifying chronic conditions by increasing the use of preventive care improving coordination of care across health system levels and increasing patient involvement in care These elements can improve patient health and quality of life and may reduce the need for curative and higher-level medical services-for example by supporting patients with type 2 diabetes to improve their diet and increase physical activity to limit further deterioration in their health and use of emergency or specialty health services
In 2017 the World Bank EHIF and the Estonian Family Physicians Association launched a pilot of risk-stratified care management with a very small number of volunteering primary health care providers From January to February 2017 a digital environment was developed to monitor patients for family physicians It contains important data of risk patients health indicators medical history socio-economic background which can be accessed digitally by health care providers This allowed family physicians and nurses to monitor health indicators and treatment goals of high-risk patients and track the implementation of the treatment plan
The family physician and nurses responsibilities involved assessing patient needs creating treatment plans coordinating health-related activities and working with a social worker to provide social support During the pilot project family physicians collaborated with hospitals to track patient outcomes Results of the initial pilot convinced EHIF that it would be beneficial to test expansion of the ECM model nationally so a full-scale study was launched during 2020 to include a representative sample of clinics and their eligible patients nationwide
In this study the research team will conduct a randomized controlled trial in partnership with EHIF to evaluate the impact of ECM training for physicians The RCT will have enrolled a randomly selected 97 family physicians out of the 786 family physicians practicing in Estonia Among those physicians 6739 ECM-eligible patients 2389 patients will have been randomly selected for enrollment into the ECM program Using administrative records the study will evaluate the effects of ECM enrollment on 1 health care utilization 2 provider management of tracer conditions and 3 markers of quality of care such as hospital admission for primary health care-sensitive conditions
Risk-stratified care management for chronic conditions was first introduced in Estonia in 2017 to better support high-risk patients with an assortment of chronic conditions and an increased risk of healthcare utilization The Enhanced Care Management ECM program is intended to improve the quality of care provided to complex patients with qualifying chronic conditions by increasing the use of preventive care improving coordination of care across health system levels and increasing patient involvement in care These elements can improve patient health and quality of life and may reduce the need for curative and higher-level medical services-for example by supporting patients with type 2 diabetes to improve their diet and increase physical activity to limit further deterioration in their health and use of emergency or specialty health services
In 2017 the World Bank EHIF and the Estonian Family Physicians Association launched a pilot of risk-stratified care management with a very small number of volunteering primary health care providers From January to February 2017 a digital environment was developed to monitor patients for family physicians It contains important data of risk patients health indicators medical history socio-economic background which can be accessed digitally by health care providers This allowed family physicians and nurses to monitor health indicators and treatment goals of high-risk patients and track the implementation of the treatment plan
The family physician and nurses responsibilities involved assessing patient needs creating treatment plans coordinating health-related activities and working with a social worker to provide social support During the pilot project family physicians collaborated with hospitals to track patient outcomes Results of the initial pilot convinced EHIF that it would be beneficial to test expansion of the ECM model nationally so a full-scale study was launched during 2020 to include a representative sample of clinics and their eligible patients nationwide
In this study the research team will conduct a randomized controlled trial in partnership with EHIF to evaluate the impact of ECM training for physicians The RCT will have enrolled a randomly selected 97 family physicians out of the 786 family physicians practicing in Estonia Among those physicians 6739 ECM-eligible patients 2389 patients will have been randomly selected for enrollment into the ECM program Using administrative records the study will evaluate the effects of ECM enrollment on 1 health care utilization 2 provider management of tracer conditions and 3 markers of quality of care such as hospital admission for primary health care-sensitive conditions
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None