Coca: Evaluation of Programs of Coordinated Care and Disease Management

Sponsor

Mathematica Policy Research, Inc. (Other)

Overall Status

Unknown status

CT.gov ID

NCT00627029

Collaborator

Centers for Medicare and Medicaid Services (U.S. Fed)

18,277

Enrollment

Locations

Arms

195

Duration (Months)

1218.5

Patients Per Site

6.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is a Congressionally mandated study. In the original study, 16 demonstration programs provided care coordination services to beneficiaries with chronic illness in Medicare's fee-for-service program. A five-year CMS-funded study tested whether the programs can improve patients' use of medical services, improve patients' outcomes and satisfaction with care, and reduce Medicare costs. The study also assessed physicians' satisfaction with the programs.

In 2008 Congress extended the project for two of the original programs--Mercy Medical Center

North Iowa and Health Quality Partners in Pennsylvania--and they will enroll Medicare beneficiaries and provide care coordination services into the spring of 2010.

Condition or Disease	Intervention/Treatment	Phase
Congestive Heart Failure Diabetes Coronary Artery Disease Chronic Obstructive Pulmonary Disease Cancer Cerebrovascular Disease Alzheimer's Disease Psychotic Disorder Major Depression	Behavioral: Care Coordination	N/A

Detailed Description

Mathematica Policy Research, Inc. (MPR) evaluated 16 independent demonstration sites that provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The rationale for the demonstration is the lack of coordination among the multiple providers typically serving Medicare beneficiaries with chronic illnesses, as well as the adverse consequences of the lack of coordination for the beneficiaries and for Medicare costs. The demonstration sites, selected in early 2001, offered programs designed to improve both the care that patients receive and patients' knowledge of, and adherence with, recommended self-care and behavior. The study estimated the effects of each site on patients' well-being and satisfaction, in addition to the site's effects on the use and cost of Medicare covered services. This analysis relied on a patient survey conducted 6 to 12 months after enrollment, and on Medicare claims data and any data available from the demonstration sites that could enhance the study. The study included two rounds of physician surveys. In each site, eligible applicants were randomly assigned to treatment and control groups. An extensive process analysis was conducted to describe the interventions in detail, with the key goal being an assessment of those factors that account for program success and failure. The study included case studies of each site, program profiles, interim site-specific memos, two interim summary reports, two reports to Congress (based on the interim summary reports), and a final summary report. This original study enrolled 18,277 beneficiaries.

In 2008 Congress extended the study for 2 of the sites, Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania, and they will recruit beneficiaries and provide demonstration intervention services through the spring of 2010. Mathematica Policy Research will evaluate the results of this extended demonstration using Medicare claims data and qualitative site visits to the two programs.

Study Design

Study Type:

Interventional

Actual Enrollment :

18277 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Health Services Research

Official Title:

Evaluation of Programs of Coordinated Care and Disease Management

Study Start Date :

Sep 1, 2000

Actual Primary Completion Date :

Aug 1, 2015

Anticipated Study Completion Date :

Dec 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Intervention Care coordination, consisting variously (depending on the demonstration site)--nurse telephonic counseling, nurse in-person home visits, home telemonitoring equipment, and physician education and feedback.	Behavioral: Care Coordination Depending on the demonstration site, may consist of nurse telephonic counseling and monitoring, nurse in-person or home visits, home telemonitoring equipment, patient educational materials, patient group educations classes, physician education and feedback.
No Intervention: Control Usual care in Medicare fee-for-service from beneficiaries' physicians and other health care providers

Arm

Intervention/Treatment

Experimental: Intervention

Care coordination, consisting variously (depending on the demonstration site)--nurse telephonic counseling, nurse in-person home visits, home telemonitoring equipment, and physician education and feedback.

Behavioral: Care Coordination

Depending on the demonstration site, may consist of nurse telephonic counseling and monitoring, nurse in-person or home visits, home telemonitoring equipment, patient educational materials, patient group educations classes, physician education and feedback.

No Intervention: Control

Usual care in Medicare fee-for-service from beneficiaries' physicians and other health care providers

Outcome Measures

Primary Outcome Measures

Medicare program expenditures [Eight years]

Secondary Outcome Measures

Claims-based and patient-reported quality of care [Eight years]

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Meets clinical and prior health service use criteria of each of the 16 demonstration sites (vary across demonstration programs)
Resides in catchment area of one of the programs
Enrolled in Medicare fee-for-service program
Coverage by both Medicare Parts A and B
Medicare is primary payer

Exclusion Criteria:

Does not meet any of the relevant program's exclusion criteria (vary across demonstration programs)
Not enrolled in a Medicare Advantage plan (Medicare managed care program)

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Hospice of the Valley MediCaring Project	Phoenix	Arizona	United States	85016
2	Georgetown University Medical Center-Mind My Heart Program	Washington	District of Columbia	United States	20036
3	Quality Oncology/Matria Healthcare	Sunrise	Florida	United States	33323
4	CorSolutions/Matria Healthcare	Rosemont	Illinois	United States	60018
5	Carle Foundation and Hospital	Urbana	Illinois	United States	61801
6	Mercy Medical Center - North Iowa	Mason City	Iowa	United States	50401
7	Medical Care Development	Augusta	Maine	United States	04330
8	University of Maryland Medical Center	Baltimore	Maryland	United States	21201
9	Charlestown/Erickson Retirement Communities	Catonsville	Maryland	United States	21228
10	Washington University-St.Louis School of Medicine/Barnes-Jewish Hospital	St. Louis	Missouri	United States	63110
11	QMed, Inc.	Eatontown	New Jersey	United States	07724
12	Lovelace Health Systems	Albuquerque	New Mexico	United States	87102
13	Jewish Home Lifecare	New York	New York	United States	10025
14	Avera McKennan Hospital and University Health Center	Sioux Falls	South Dakota	United States	57117
15	CenVaNet	Richmond	Virginia	United States	23220