title: Implementation and effectiveness of 'care navigation', coordinated management for people with complex chronic illness: rationale and methods of a randomised controlled trial.
abstract: BACKGROUND
  Chronic illness is a significant driver of the global burden of disease and associated health care costs. People living with severe chronic illness are heavy users of acute hospital services; better coordination of their care could potentially improve health outcomes while reducing hospital use. The Care Navigation trial will evaluate an in-hospital coordinated care intervention on health service use and quality of life in chronically ill patients.
  
  
  METHODS
  A randomised controlled trial in 500 chronically ill patients presenting to the emergency department of a hospital in Western Sydney, Australia. Participants have three or more hospital admissions within a previous 12 month period and either aged ≥70 years; or aged ≥45 years and of Aboriginal or Torres Strait Islander descent; or aged ≥ 16 with a diagnosis of a respiratory or cardiology related illness. Patients are randomised to either the coordinated care program (Care Navigation), or to usual care. The Care Navigation program consists of dedicated nurses who conduct patient risk assessments, oversee patient nursing while in hospital, and guide development of a care plan for the management of chronic illness after being discharged from hospital. These nurses also book community appointments and liaise with general practitioners. The main outcome variables are the number of emergency department re-presentations and hospital readmissions, and quality of life during a 24 month follow-up. Secondary outcomes are length of hospital stay, mortality, time to first hospital re-admission, time to first emergency department re-presentation, patient satisfaction, adherence to prescribed medications, amount and type of in-hospital referrals made for consultations and diagnostic testing, and the number and type of community health referrals. A process evaluation and economic analysis will be conducted alongside the randomised trial.
  
  
  CONCLUSIONS
  A trial of in-hospital care coordination may support recent evidence that engaging primary health services in care plans linked to multidisciplinary team support improves patient outcomes and reduces costs to the health system. This will inform local, national and international health policy.
  
  
  BACKGROUND
  Australia New Zealand Clinical Trials Registry ACTRN12609000554268.
authors: Natalie
authors: N
authors: Plant
authors: Kylie-Ann
authors: KA
authors: Mallitt
authors: Patrick J
authors: PJ
authors: Kelly
authors: Tim
authors: T
authors: Usherwood
authors: James
authors: J
authors: Gillespie
authors: Steven
authors: S
authors: Boyages
authors: Stephen
authors: S
authors: Jan
authors: Justin
authors: J
authors: McNab
authors: Beverley M
authors: BM
authors: Essue
authors: Kathy
authors: K
authors: Gradidge
authors: Nereus
authors: N
authors: Maranan
authors: David
authors: D
authors: Ralphs
authors: Clive
authors: C
authors: Aspin
authors: Stephen
authors: S
authors: Leeder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062526:Patient Navigation / Q000379:methods* / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D012107:Research Design; D014904:Western Australia; D055815:Young Adult
references: Int J Integr Care. 2002;2:e12
references: 16896389
references: Int J Geriatr Psychiatry. 2003 Mar;18(3):222-35
references: 12642892
references: Health Policy. 1996 Jul;37(1):53-72
references: 10158943
references: Int J Integr Care. 2011 Jan;11(Spec 10th Anniversary Ed):e141
references: 22375101
references: BMJ. 1998 May 2;316(7141):1348-51
references: 9563983
references: Int J Qual Health Care. 2005 Apr;17(2):141-6
references: 15665066
references: Int J Qual Health Care. 2002 Oct;14(5):353-8
references: 12389801
references: Med J Aust. 2008 Apr 21;188(S8):S53-6
references: 18429737
references: Med Care. 1986 Jan;24(1):67-74
references: 3945130
references: Int J Health Plann Manage. 2005 Apr-Jun;20(2):159-80
references: 15991460
references: BMJ. 2012 May 31;344:e3529
references: 22654064
references: BMJ. 1998 Jan 10;316(7125):133-7
references: 9462322
references: BMJ. 2012 Jul 13;345:e4451
references: 22797845