Evaluating the Impact of a Supportive Care Program

NYU Langone Health1,201 enrolled

Overview

NYU's High Risk Program targets patients who may be more likely to have increased hospitalization due to health conditions that may cause death in the near future. Community Health Workers, a home visiting doctor service, a supportive care nurse, and behavioral health specialist engage the population to address a range of biopsychosocial needs with end goal in increasing support in the community and engaging palliative and hospice care when appropriate to prevent hospital readmissions, shorten length of stay, reduce hospital utilization, and decrease overall patient cost with a focus on hospital spend.

Study Type

OBSERVATIONAL

Enrollment

1,201

Conditions

Patient Engagement Morality

Interventions

Supportive care programBEHAVIORAL

Community Health Workers, a home visiting doctor service, a supportive care nurse, and behavioral health specialist engage the population to address a range of biopsychosocial needs with end goal in increasing support in the community and engaging palliative and hospice care when appropriate to prevent hospital readmissions, shorten length of stay, reduce hospital utilization, and decrease overall patient cost with a focus on hospital spend.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or older * at or above the 75th percentile on the Mortality Model * Attributed to a value based contract Exclusion Criteria: * Less than 18 years of age * Below the 75th percentile on the Mortality Model * Not attributed to a value based contract

Locations (1)

NYU Langone Health

New York, New York, United States

Outcomes

Primary Outcomes

Rate of Advance Care Planning note creation

How many and how often are ACP notes written for patients

Time frame: 2 years

Data from ClinicalTrials.gov

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