Community-Informed Interventions for Equitable Congestive Heart Failure Management in Primary Care | NCT07730827

NCT07730827

Overview

NCT ID: NCT07730827
Lead Sponsor: Mayo ClinicOTHER
Official Title: Community-Informed Interventions for Equitable Congestive Heart Failure Management in Primary Care
Brief Summary: The purpose of this study is to expand subject matter expertise and sustained capacity for equity-oriented care within the Advanced Care Ecosystem (ACE) by engaging patients, caregivers, community health workers (CHW), and care-team stakeholders in development work focused on adults living with congestive heart failure (CHF) and adverse social determinants of health (SDoH).
Conditions: Congestive Heart Failure
Heart Failure
Interventions

Ages Eligible for Study: Adult (18-64)Older Adult (65+)
Sexes Eligible for Study: All
Accepts Healthy Volunteers?: No
Eligibility Criteria: Inclusion Criteria:

Patients living with congestive heart failure (CHF):

Age 18 years or older.

Diagnosis or clinical documentation of CHF or heart failure in the Mayo Clinic medical record.

Empaneled in Mayo Clinic, Rochester, primary care

Evidence in the EHR of one or more adverse SDoH, elevated utilization, medical/social complexity.

Able to provide informed consent.

Able to participate in study procedures.

Caregivers:

Age 18 years or older.

Caregiver with relevant lived, caregiving, or community experience related to CHF, and nominated by the patient.

Able to provide informed consent

Able to participate in study procedures.

Community health worker and care-team stakeholders:

Age 18 years or older.

Current or recent role relevant to CHF care, transitions of care, SDoH, patient education, or CHW workflows.

Able to provide informed consent

Able to participate in study procedures.

Exclusion Criteria:

Under age 18 years.

Unable or unwilling to provide informed consent.

Participant Group/Arms

Adults living with congestive heart failure (CHF)

Adults living with CHF receiving primary care at Mayo Clinic Rochester with adverse SDoH, elevated utilization, or related medical/social complexity

Other: Interviews and group discussion for patients and caregivers

Caregivers or family members of eligible congestive heart failure (CHF) patients

Caregivers or family members of eligible CHF patients nominated by the patient

Other: Interviews and group discussion for patients and caregivers

Community health workers and care-team stakeholders

Community health workers, chronic disease RN care coordinators, education specialists, clinicians, and operational leaders

Other: Interviews and group discussion for community health worker and care-team stakeholders