Status:
NOT_YET_RECRUITING
Annual Wellness Visits vs GRACE-augmented Annual Wellness Visits For Older Adults With High Needs - Phase 2
Lead Sponsor:
Massachusetts General Hospital
Collaborating Sponsors:
Brandeis University
Indiana University School of Medicine
Conditions:
Aging
Preventive Care
Eligibility:
All Genders
18+ years
Phase:
NA
Brief Summary
This study consists of three aims focused on examining the feasibility of adding the Geriatric Resources and Assessment for the Care of Elders (GRACE) model to structured Annual Wellness Visits (AWVs)...
Detailed Description
In the United States, 10% of patients account for half of health care costs. Many of these are older adults with complex health and social care needs (referred to as "older adults with complex needs")...
Eligibility Criteria
Inclusion
- Patient Inclusion Criteria:
- Age 65 years or older
- Eligible for an AWV (Medicare/Medicare Advantage) during the study period
- Residential mailing address within a radius of the practice that can be achievably reached via a home visit
- English or Spanish speaking
- Be able to provide consent and / or have a proxy able to consent to study participation.
- Meet criteria for complex health care needs, by virtue of having a Probability of Repeated Admissions (PRA) score of 0.35 or greater AND/OR Kim Syndrome on Aging (efrailty indicator) score of 0.35 or greater
- Caregiver Inclusion Criteria:
- Age 18 years or older
- English or Spanish speaking
- Be able to provide consent to study participation
- Be identified by an eligible patient for participation in the study
- Clinician Inclusion Criteria:
- Age 18 years or older
- English or Spanish speaking
- Be able to provide consent to study participation
- Adult health professionals who work at participating ACOs and primary care practice sites (e.g. physicians, advanced practice clinicians, nurses, social workers, clinic staff.)
Exclusion
Key Trial Info
Start Date :
January 1 2026
Trial Type :
INTERVENTIONAL
Allocation :
ESTIMATED
End Date :
January 1 2030
Estimated Enrollment :
6080 Patients enrolled
Trial Details
Trial ID
NCT07166861
Start Date
January 1 2026
End Date
January 1 2030
Last Update
December 30 2025
Active Locations (4)
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1
Griffin Health
Derby, Connecticut, United States, 06418
2
Mass General Brigham
Boston, Massachusetts, United States, 02124
3
Atrium Health Wake Forest Baptist
Winston-Salem, North Carolina, United States, 27157
4
Baylor Scott & White Health
Temple, Texas, United States, 76508