• Douglas W Roblin, Joel E Segel, Richard J McCarthy, and Neeraj Mendiratta.
• Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA. Douglas.W.Roblin@KP.Org.
• J Gen Intern Med. 2021 Jul 1; 36 (7): 2021-2029.

BackgroundHigh-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel.ObjectiveEvaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP.DesignRetrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients.SettingKaiser Permanente Mid-Atlantic States (KPMAS) during 2017-2018.ParticipantsNine hundred twenty-nine CCP patients empaneled January 2017-June 2018, 929 matched control patients for the same period.InterventionsThe KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations.Main OutcomesTime to death and time to first hospital admission in the 180 days following empanelment or eligibility.ResultsCompared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084).LimitationsNon-randomized intervention; single healthcare system; patient eligibility limited to specific conditions.ConclusionThe KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.© 2021. Society of General Internal Medicine.

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