title: Medical Assistant-Based Care Management for High-Risk Patients in Small Primary Care Practices: A Cluster Randomized Clinical Trial.
abstract: BACKGROUND
  Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices.
  
  
  OBJECTIVE
  To determine whether protocol-based care management delivered by medical assistants improves care in patients at high risk for future hospitalization in primary care.
  
  
  METHODS
  Two-year cluster randomized clinical trial. (Current Controlled Trials: ISRCTN56104508).
  
  
  METHODS
  115 primary care practices in Germany.
  
  
  METHODS
  2076 patients with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by an analysis of insurance data.
  
  
  METHODS
  Protocol-based care management, including structured assessment, action planning, and monitoring delivered by medical assistants, compared with usual care.
  
  
  METHODS
  All-cause hospitalizations at 12 months (primary outcome) and quality-of-life scores (12-Item Short Form Health Survey [SF-12] and EuroQol instrument [EQ-5D]).
  
  
  RESULTS
  Included patients had an average of 4 co-occurring chronic conditions. All-cause hospitalizations did not differ between groups at 12 months (risk ratio [RR], 1.01 [95% CI, 0.87 to 1.18]) and 24 months (RR, 0.98 [CI, 0.85 to 1.12]). Quality of life (differences, 1.16 [CI, 0.24 to 2.08] on SF-12 physical component and 1.68 [CI, 0.60 to 2.77] on SF-12 mental component) and general health (difference on EQ-5D, 0.03 [CI, 0.00 to 0.05]) improved significantly at 24 months. Intervention costs totaled $10 per patient per month.
  
  
  CONCLUSIONS
  Small number of primary care practices and low intensity of intervention.
  
  
  CONCLUSIONS
  This low-intensity intervention did not reduce all-cause hospitalizations but showed positive effects on quality of life at reasonable costs in high-risk multimorbid patients.
  
  
  BACKGROUND
  AOK Baden-Württemberg and AOK Bundesverband.
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
authors.forename: Frank
authors.initials: F
authors.lastname: Peters-Klimm
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Cornelia
authors.initials: C
authors.lastname: Mahler
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
authors.forename: Antje
authors.initials: A
authors.lastname: Erler
authors.forename: Martin
authors.initials: M
authors.lastname: Beyer
authors.forename: Matthias
authors.initials: M
authors.lastname: Gondan
authors.forename: Justine
authors.initials: J
authors.lastname: Rochon
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Gerlach
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010823:Physician Assistants / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011787:Quality of Health Care; D011788:Quality of Life; D012307:Risk Factors; D012648:Self Care