Evidence map›Paper›PMID 39075268›Full record

Trial reportJournal of general internal medicine2025

Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Evelyn T Chang, Alexis Huynh, Caroline Yoo, Jean Yoon, Donna M Zulman, Michael K Ong, Melissa Klein, Jessica Eng, Sudip Roy, Susan E Stockdale and 5 more

Registry-linked trialAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04521816 (PIM 2.0), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04521816 nacompletednot on this map

PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project

TypeinterventionalSponsorVeteran Affairs Office of Patient Care ServicesRan2017 to 2018Enrolled599ConditionsPrimary Health Care, Health Care CostsArmsPACT Intensive Management
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Evelyn T ChangVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA. Evelyn.Chang@va.gov.ORCID 0000-0002-6755-1566
Alexis HuynhVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Caroline YooVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Jean YoonVHA Health Economics Resource Center (HERC), Menlo Park, CA, USA.
Donna M ZulmanVHA HSR Center for Innovation to Implementation, Menlo Park, CA, USA.
Michael K OngVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Melissa KleinDepartment of Medicine, VHA Northeast Ohio Healthcare System, Cleveland, OH, USA.
Jessica EngOn Lok Program of All-Inclusive Care for the Elderly (PACE), San Francisco, CA, USA.
Sudip RoyVHA Salisbury Healthcare System, Salisbury, NC, USA.
Susan E StockdaleVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Elvira E JimenezVHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.
Angela DenietolisVHA Office of Primary Care, 810 Vermont Ave, Washington, DC, 20420, USA.
Jack NeedlemanDepartment of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.
Steven M AschVHA HSR Center for Innovation to Implementation, Menlo Park, CA, USA.
PACT Intensive Management (PIM) Demonstration Sites, PIM National Evaluation Center, and PIM Executive Committee

Funding

Office of Patient Care Services, Department of Veterans Affairs XVA 65-54
6 · The paper itself

Abstract

backgroundMany healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs.

objectiveThe Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs.

designRetrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score.

participantsVeterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit.

interventionPIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services. MAIN OUTCOMES AND MEASURES: Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12 months pre- and post-index date. KEY

resultsOf the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM. CONCLUSIONS AND RELEVANCE: VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes.

trial registrationPIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.

Indexed as

Ambulatory CarePrimary Health CareReferral and ConsultationAgedCohort StudiesFemaleHospitalizationHumansMaleMiddle AgedPropensity ScoreRetrospective StudiesUnited StatesUnited States Department of Veterans AffairsVeteranscase managementmultimorbiditypatient care teamveterans health services

Identifiers

PMID39075268
PMCPMC11861449

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.