Nutritional and Metabolic Diseases

Gland and Hormone Related Diseases

All Conditions

Behaviors and Mental Disorders

Nervous System Diseases

Respiratory Tract (Lung and Bronchial) Diseases

Symptoms and General Pathology

Heart and Blood Diseases

Rare Diseases

Diabetes Mellitus

Depressive Disorder

Mental Disorders

Alzheimer Disease

Lung Diseases, Obstructive

Pulmonary Disease, Chronic Obstructive

Depressive Disorder, Major

Depression

Heart Failure

Coronary Artery Disease

Myocardial Ischemia

Coronary Disease

Lung Diseases

Cerebrovascular Disorders

Psychotic Disorders

Heart Diseases

Dementia

Brain Diseases

Central Nervous System Diseases

Tauopathies

Neurodegenerative Diseases

Neurocognitive Disorders

Respiratory Tract Diseases

Ischemia

Arteriosclerosis

Arterial Occlusive Diseases

Vascular Diseases

Chronic Disease

Disease Attributes

Schizophrenia

Schizophrenia Spectrum and Other Psychotic Disorders

Familial Alzheimer Disease

Chronic Graft Versus Host Disease

Care coordination, consisting variously (depending on the demonstration site)--nurse telephonic counseling, nurse in-person home visits, home telemonitoring equipment, and physician education and feedback.

Usual care in Medicare fee-for-service from beneficiaries' physicians and other health care providers

Depending on the demonstration site, may consist of nurse telephonic counseling and monitoring, nurse in-person or home visits, home telemonitoring equipment, patient educational materials, patient group educations classes, physician education and feedback.

Care Coordination

Randall S. Brown, Ph.D.

Carol A. Magee, Ph.D.

This is a Congressionally mandated study. In the original study, 16 demonstration programs provided care coordination services to beneficiaries with chronic illness in Medicare's fee-for-service program. A five-year CMS-funded study tested whether the programs can improve patients' use of medical services, improve patients' outcomes and satisfaction with care, and reduce Medicare costs. The study also assessed physicians' satisfaction with the programs.

In 2008 Congress extended the project for two of the original programs--Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania--and they will enroll Medicare beneficiaries and provide care coordination services into the spring of 2010.

Mathematica Policy Research, Inc. (MPR) evaluated 16 independent demonstration sites that provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The rationale for the demonstration is the lack of coordination among the multiple providers typically serving Medicare beneficiaries with chronic illnesses, as well as the adverse consequences of the lack of coordination for the beneficiaries and for Medicare costs. The demonstration sites, selected in early 2001, offered programs designed to improve both the care that patients receive and patients' knowledge of, and adherence with, recommended self-care and behavior. The study estimated the effects of each site on patients' well-being and satisfaction, in addition to the site's effects on the use and cost of Medicare covered services. This analysis relied on a patient survey conducted 6 to 12 months after enrollment, and on Medicare claims data and any data available from the demonstration sites that could enhance the study. The study included two rounds of physician surveys. In each site, eligible applicants were randomly assigned to treatment and control groups. An extensive process analysis was conducted to describe the interventions in detail, with the key goal being an assessment of those factors that account for program success and failure. The study included case studies of each site, program profiles, interim site-specific memos, two interim summary reports, two reports to Congress (based on the interim summary reports), and a final summary report. This original study enrolled 18,277 beneficiaries.

In 2008 Congress extended the study for 2 of the sites, Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania, and they will recruit beneficiaries and provide demonstration intervention services through the spring of 2010. Mathematica Policy Research will evaluate the results of this extended demonstration using Medicare claims data and qualitative site visits to the two programs.

Evaluation of Programs of Coordinated Care and Disease Management

Centers for Medicare and Medicaid Services

Mathematica Policy Research, Inc.

Subjects will complete 2 online surveys over the course of 1 month; each should take about 15 minutes to complete.

Questionnaire identifying cancer needs so that providers can connect subjects with services that might address them.

AYA NA-SB Questionnaire

Emily Haines, MD

The purpose of this research is to test an intervention designed to identify cancer needs and connect patients with services that address those needs. Participation in this research will involve completing 2 online surveys over the course of 1 month; each should take about 15 minutes to complete.

Adolescents and young Adults (AYA) Needs Assessment \& Service Bridge (AYA NA-SB) includes a holistic Patient Reported Outcome Measures (PROM) assessing AYAs' physical, psychosocial and practical needs and a collection of referral pathways for connecting AYAs to services and resources based on the needs they report.

To assess the implementation of AYA NA-SB, the study team will pilot AYA NA-SB in the North Carolina Cancer Hospital (NCCH)/ UNC Children's Hospital, with a primary focus on implementation outcomes (i.e., feasibility, acceptability, appropriateness, fidelity). To establish proof-of-concept for AYA NA-SB, the study team will use pilot data to generate preliminary evidence on the extent to which AYA NA-SB addresses AYAs' reported needs.

Improving Care Coordination for Adolescents and Young Adults With Cancer

Improving Care Coordination for Adolescents and Young Adults With Cancer: Implementing a Bridge Between Needs and Services

Questionnaire measuring the extent to which AYA NA-SB can be successfully used in cancer programs. Score ranges from 1 to 5 with higher score denoting higher feasibility.

Questionnaire measuring perception of whether AYA-NA-SB is agreeable, palatable, or satisfactory to users. Score ranges from 1 to 5 with a higher score denoting higher acceptability.

Questionnaire measuring perception of AYA-NA-SB's fit, relevance, or compatibility with the context in which it will be used. Score ranges from 1 to 5 with a higher score denoting higher appropriateness

Care coordination will be assessed by the proportion of Adolescents and Young Adults (AYAs) who reported needs who received services from across disciplines to address reported needs within one month of needs assessment completion.

Questionnaire assessing, among AYAs who reported needs and reported receiving follow-up care, AYAs' perception of the degree to which their needs were adequately addressed during the study period. Scores range from 1 to 5 where higher scores denote that needs were met.

Average number of needs reported by AYAs.

National Cancer Institute (NCI)

Wake Forest University Health Sciences

In this single-arm feasibility pilot, the treatment arm completed the NA-SB Needs Assessment at baseline through a secure online survey platform, REDCap. The 57 items assessing AYAs' physical, psychosocial, practical need were preceded by items collecting demographic and clinical information from respondents. AYAs received a $15 incentive for completing the needs assessment. An AYA social worker or AYA nurse practitioner then reviewed their NA-SB Needs Assessment with them, addressed any needs that fell within their purview, and initiated referral pathways for any remaining needs. One month following completion of the NA-SB needs assessment, we engaged AYA pilot participants in an electronic postintervention survey assessing their perceptions of NA-SB and whether their needs were met. The postintervention survey was administered through REDCap and AYAs received a second $15 incentive for completing it.

Treatment Arm

Age, Continuous

Sex: Female, Male

Non-Hispanic White

Non-Hispanic Black

Hispanic (all races)

Non-Hispanic American Indian/Alaska Native

OTHER

Race/Ethnicity, Customized

Leukemia

Breast

Cervical

Sarcoma

Male Reproductive

Non-Hodgkin Lymphoma

Hodgkin Lymphoma

Other female reproductive

Other

Cancer diagnosis

<3 months

3-6 months

7-12 months

>12 months

Time since diagnosis

I/II

III/IV

Unknown/ unstaged

Participants self-reported cancer stage at diagnosis based on the information provided to them by their oncology care team. The "unknown/unstaged" option is for those who did not receive or remember receiving this information. Participants' respective physicians may have defined stages differently. In general, stage 0 is considered earliest/least advanced stage of cancer while stage IV describes most advanced cancer/ metastatic cancer. A higher stage represents more advanced cancer.

Stage at diagnosis

Employer/school

Spouse's employer/school

Parent

Medicaid

Medicare

Military/TRICARE

No insurance

Self-pay

Insurance source

Lives alone

Parent(s)

Sibling(s)

Spouse/partner

Roommate(s)

Cohabitants

In school

Not in school

School status

Working

Not working

Working status

Dr. Emily Haines

Feasibility of Intervention Measure (FIM) AYA

Acceptability of Intervention Measure (AIM) AYA

Intervention Appropriateness Measure (IAM) AYA

young adults with cancer who reported needs

Number of Participants Who Received Services

young adults with cancer who reported needs and reported receiving follow-up care

Needs Met Questionnaire

Number of AYA Needs

Overall Study

Neoplasms

Lung Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Pharmaceutical Solutions

All Drugs and Chemicals

Patients and caregivers enroll in using care coordination tool during oncology care and treatment.

Patients and caregivers receive oncology care and treatment.

Oncology care providers with patients enrolled in care coordination tool.

Participants will be asked to enroll in the care coordination tool, a health information technology solution that integrates cross-sector data to enhance communication and improve quality of care and performance outcomes. Patients will also be asked to provide consent to allow the study team to access additional health information via the electronic health record.

Care coordination tool

Lisa Bailey-Davis, DEd, RD

The Oncology Care Coordination study is designed to evaluate use of a care coordination tool for lung cancer patients and their caregiver on quality of care and performance outcomes. Eligible patients need to be receiving treatment at Geisinger. Participation in the study involves completion of surveys, permission to review information from the patient's electronic health record, and for some enrollment in the care coordination tool called Harmonized Care. Geisinger oncology care providers who have patients enrolled the study will be invited for interviews.

The case-matched controlled design, exploratory evaluation study will look at how exposure to a care coordination tool impacts quality and performance indicators associated with oncology care from the perspective of patients, caregivers, and providers.

Geisinger research staff will recruit lung cancer patients and their caregivers across three Geisinger locations: Geisinger Medical Center (GMC), Geisinger Wyoming Valley Medical Center (GWV) and Geisinger Community Medical Center (GCMC). GMC will serve as the intervention site and GWV and GCMC as control sites.

Eligible participants will be identified by the study staff through the electronic health record as well as through clinical staff and approached in the oncology clinic as part of a schedule office visit and/or treatment. For the purpose of study awareness, informational flyers will be available to patients in the exam rooms, waiting rooms, and through Oncology Care's Multi-Disciplinary clinic. Participants will asked to identify a caregiver who will participate in the study as well, however this is not required.

Case dyads enrolled at the intervention site (GMC) will be asked to complete a survey when they join the study and at the end of the study. Participants will also be asked to enroll in the care coordination tool, a health information solution that integrates the patient, caregiver, and clinical data to enhance communication and improve quality of care and performance outcomes. Patients will also be asked to give permission to the study team to access their health information via the e electronic health record. Participants will be in the research study for about 8-10 weeks.

Control dyads enrolled at the control site (GWV and GCMC) will be asked to complete a survey eight weeks after consenting to participate. Patients will be asked to give permission to the study team to access their health information via the electronic health record. Participants will be in the research study for about 8-10 weeks.

The study will also enroll oncology care providers within the Medical Oncology or Radiation Oncology departments at GMC and who have patients enrolled in the study. Providers will be asked to participate in a 30-minute interview to get their feedback and insights on the care coordination tool.

Care Coordination in Oncology, Quality Among Patients With Lung Cancer and Their Caregivers

Exploratory Evaluation of Family Caregiver Application (FCA) on Quality Among Persons With Lung Cancer and Their Family Caregivers

To evaluate the difference in patient satisfaction associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control patient analyses will also be performed to detect role-level differences in perceptions of satisfaction associated with FCA exposure.To evaluate the association of the change in patient satisfaction associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in satisfaction perceptions based on role.

To evaluate the difference in caregiver satisfaction associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control caregiver analyses will also be performed to detect role-level differences in perceptions of satisfaction associated with FCA exposure. To evaluate the association of the change in caregiver satisfaction associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in satisfaction perceptions based on role.

To evaluate the difference in patient quality of life associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control patient analyses will also be performed to detect role-level differences in perceptions of quality of life associated with FCA exposure.To evaluate the association of the change in patient quality of life associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in quality of life perceptions based on role.

To evaluate the difference in caregiver quality of life associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control caregiver analyses will also be performed to detect role-level differences in perceptions of quality of life associated with FCA exposure. To evaluate the association of the change in caregiver quality of life associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in quality of life perceptions based on role.

To evaluate the difference in family centered care associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control patient and caregiver analyses will also be performed to detect role-level differences in perceptions of family centered care associated with FCA exposure. To evaluate the association of the change in family centered care associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in family centered care perceptions based on role.

To evaluate the difference in patient experience associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean patient and caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control patient analyses will also be performed to detect role-level differences in perceptions of experience associated with FCA exposure.To evaluate the association of the change in patient experience associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. Within Case Dyads, patient means will be compared with caregiver means to detect difference in experience perceptions based on role.

To evaluate the difference in caregiver burden associated with FCA exposure (Case v. Control) will be evaluated using chi-square test, t-tests and non-parametric univariate tests distribution dependent. Mean caregiver scores will be calculated for each dyad and compared between groups. Sensitivity analyses may stratify by level of FCA use (low-moderate-high) per dyad and opportunity time for FCA exposure. Case to Control caregiver analyses will also be performed to detect role-level differences in perceptions of burden associated with FCA exposure.To evaluate the association of the change in caregiver burden associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution. To evaluate the association of the change in caregiver burden associated with FCA use difference in response between pre- and post- surveys paired t-test or ANCOVA depending on data type and distribution.

Merck Sharp & Dohme LLC

Geisinger Clinic

Diseases and Abnormalities at or Before Birth

Wounds and Injuries

Cerebral Palsy

Paralysis

Metabolic Diseases

Heart Defects, Congenital

Metabolism, Inborn Errors

Brain Injuries

Brain Damage, Chronic

Congenital Abnormalities

Cardiovascular Abnormalities

Genetic Diseases, Inborn

Receipt of a novel mobile-health tool, GoalKeeper Plus Standard Care

Mobile-health communication tool for parents of children with medical complexity

GoalKeeper

Standard Care

Lee M Sanders, MD, MPH

This proposal addresses the major challenge of improving health outcomes for children with cancer and other complex conditions, for whom the effectiveness of outpatient care depends on care coordination across a diverse group of caregivers that includes parents, community support organizations and pediatric care providers. The investigators have developed GoalKeeper, a prototype system for supporting care coordination across multiple care providers. The primary aim of the clinical trial is to assess the potential for this new system, GoalKeeper, to improve meaningful use of goal-centered care plans in the care of children with cancer and other complex chronic conditions.

The overarching aim of the research is to improve care coordination and goal setting for children with medical complexity (CMC). Specific aims of the pilot clinical trail are as follows: (1) To assess the efficacy of GoalKeeper on goal-setting in the health care encounter. (2) To examine the roles of parent health literacy and parent activation in moderating the effect of the intervention.

Study Population: Stanford's Primary and Subspecialty Care Clinics at Stanford Children's Health will serve as the setting for study recruitment.

The pilot randomized controlled trial will enroll 60 parents of children with medical complexity and their health-care providers. Eligibility criteria for participants will be age 18 years or older, English-speaking, and (for parents) child\<12 years old. Exclusion criteria are parent with known mental illness or neurocognitive impairment. A stepped wedge approach by provider will introduce families to GoalKeeper at different time points in the study. A pre-intervention period will occur at least 1 month before the trial start where clinical observations and baseline survey information will be obtained of each providers' practice.

Each family will be given training and 4-month access to the GoalKeeper application and participate in an exit interview at the end of study.

GoalKeeper: Intelligent Information Sharing for Children With Medical Complexity

Intelligent Information Sharing: Advancing Teamwork in Complex Care

Parent perception will be measured using the "National Survey of Children with Special Health Care Needs Shared Decision Making Domain," which includes 4 domain items each with a scale of 1 (never), 2 (sometimes), 3 (usually) or 4 (always). Positive SDM is defined as parent report of "usually" or "always" on all 4 items. Shared decision making refers to a communication process where parents and providers participate in decision making to reach treatment plan agreement.

Parent perception of goal-centered care will be measured using a modified version of the "Patient Assessment of Chronic Illness Care, Goal-Setting Domain" questionnaire, using a scale of 1(Almost Never) to 5 (Almost Always) with higher values representing better goal-centered care.

Change in perception in quality of goal-centered care will be assessed by Investigators based on parent baseline interviews and parent exit interviews.

Harvard University

Stanford University

Skin and Connective Tissue Diseases

Digestive System Diseases

Breast Neoplasms

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Patients eligible for the study who will receive Care Coordination Strategies.

Co-located Care coordinator will use EMR-driven registry to facilitate patient transitions between primary care and oncology care and enhance teamwork through coaching and technical assistance.

Care Coordination Strategies

Simon Craddock Lee, PhD, MPH

Bijal Balasubramanian, MD, PhD

Nearly 70% of people living with cancer are "complex patients" with multiple chronic conditions who must deal not only with effects of their cancer but also continuing diseases such as diabetes, depression, hypertension, or heart disease. Care coordination strategies shown to be effective in improving outcomes for common medical conditions seen in primary care include: systematic transitions for patients to and from specialty care; intensive case management; and a team-based approach to comprehensive care. Despite an Institute of Medicine report suggesting these strategies as potential ways to improve care for cancer survivors, their implementation has not yet been evaluated for cancer survivors. Parkland Health and Hospital Systems will be implementing care coordinator strategies as part of as quality assurance/quality improvement activities, which Aim 2 and Aim 3 (research components) will evaluate. This protocol has been organized to reflect this distinction between the aims. The investigators expect no more than 1500 patients to be included in these study aims.

This project is a pragmatic trial. The investigators propose a quasi-experimental design where data will be collected both pre- and post-intervention on distinct cross-sections of patients with one or more highly prevalent ambulatory-sensitive chronic conditions (diabetes, hypertension, chronic lung disease, chronic kidney disease, depression, or heart disease) and newly diagnosed with breast, colorectal, or gynecologic cancers (complex cancer survivors) in the Parkland Health \& Hospital system (Dallas, TX).

Guided by the "Primary Care Change Model", Parkland will implement evidence-based care coordination strategies to improve care for complex cancer survivors in this integrated safety-net system as a part of quality assurance/quality improvement activities (Aim 1), then this study will comprehensively evaluate how these strategies are implemented in the safety-net setting (Aim 3), and whether implementing these strategies improves care coordination and care outcomes (Aim 2) within the Parkland Health and Hospital System. Investigators expect approximately 1000 new survivors with ≥ 1 prevalent chronic condition to be eligible. The project does not include patients diagnosed with in situ and metastatic disease (Stages 0 and IV) due to insufficient evidence for routine follow-up and management; many of the latter continue indefinitely on active treatment for symptom management. The chronic conditions selected for inclusion are the most prevalent conditions cancer survivors have at Parkland as well as nationally.

* Aim 1: (Quality Assurance/ Improvement) Implement a system-level EMR-driven intervention for approximately 1000 complex cancer survivors at Parkland, combining three evidence-based care coordination strategies; (1) EMR-driven registry to facilitate patient transitions between primary care and oncology care, (2) co-locate a nurse practitioner trained in care coordination within a complex care team, and (3) enhance teamwork through coaching and technical assistance;
* Aim 2: (Research component) Test effectiveness of the strategies on system- and patient-level outcomes using a rigorous, quasi-experimental design with outcomes measured before and after implementation;
* Aim 3: (Research Component) Elucidate system and patient factors that facilitate or hinder implementation and result in differences in experiences of care coordination between complex patients with and without cancer. Investigators will collect quantitative (EMR data, patient surveys) and qualitative (structured observations, patient and provider interviews, EMR audits) data throughout.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Evaluation of Programs of Coordinated Care and Disease Management	NCT00627029	Congestive Hear... Diabetes Coronary Artery... Chronic Obstruc... Cancer Cerebrovascular... Alzheimer's Dis... Psychotic Disor... Major Depressio...	Care Coordinati...	-	Mathematica Policy Research, Inc.
Improving Care Coordination for Adolescents and Young Adults With Cancer	NCT04586127	Cancer	AYA NA-SB Quest...	18 Years - 39 Years	Wake Forest University Health Sciences
Care Coordination in Oncology, Quality Among Patients With Lung Cancer and Their Caregivers	NCT03694054	Lung Cancer	Care coordinati...	18 Years -	Geisinger Clinic
GoalKeeper: Intelligent Information Sharing for Children With Medical Complexity	NCT03620071	Childhood Cance... Cerebral Palsy Chronic Lung Di... Congenital Hear... Congenital Meta... Gastrostomy	GoalKeeper Standard Care	18 Years -	Stanford University
Evaluation of Programs of Coordinated Care and Disease Management	NCT00627029	Congestive Hear... Diabetes Coronary Artery... Chronic Obstruc... Cancer Cerebrovascular... Alzheimer's Dis... Psychotic Disor... Major Depressio...	Care Coordinati...	-	Mathematica Policy Research, Inc.
Care Coordination for Complex Cancer Survivors in an Integrated Safety Net System	NCT02943265	Breast Cancer Colorectal Canc...	Care Coordinati...	18 Years -	University of Texas Southwestern Medical Center
Evaluation of Programs of Coordinated Care and Disease Management	NCT00627029	Congestive Hear... Diabetes Coronary Artery... Chronic Obstruc... Cancer Cerebrovascular... Alzheimer's Dis... Psychotic Disor... Major Depressio...	Care Coordinati...	-	Mathematica Policy Research, Inc.
ReVital-CORE Program	NCT04852575	Frailty Cancer Chemotherapy-In...		18 Years -	Kessler Foundation
Care Coordination in Oncology, Quality Among Patients With Lung Cancer and Their Caregivers	NCT03694054	Lung Cancer	Care coordinati...	18 Years -	Geisinger Clinic
GoalKeeper: Intelligent Information Sharing for Children With Medical Complexity	NCT03620071	Childhood Cance... Cerebral Palsy Chronic Lung Di... Congenital Hear... Congenital Meta... Gastrostomy	GoalKeeper Standard Care	18 Years -	Stanford University

Spots Global Cancer Trial Database for care coordination