Controlled Trial of Tele-Support and Education for Womens Health Care in CBOCs

NCT01918072 | Completed Results

• 1 other identifier: CRE 12-031
• Study Type: observational
• Target: 202
• Locations: 1 country
• Sites: 1

Brief Summary

VA community-based outpatient clinics (CBOCs) typically serve only a small number of women Veterans, and generally do not have the women's health care resources that are available in larger settings. Women Veterans using these sites for primary care must sometimes travel to other sites to receive women's health care. That can create travel burdens, reduce continuity of care, and negatively affect patient outcomes. To address this, VA is implementing a clinical operations innovation that supports women's primary care providers with a technology-based intervention that combines interactive communication with women's health specialists and ongoing education. This research study is evaluating the implementation and effects of this women's healthcare delivery innovation. Findings from this research will inform VA women's health clinical practice and education, and will advance science in delivering technology-supported non-face-to-face care that is applicable to other clinical conditions and patient populations.

Conditions

Metrorrhagia; Urinary Incontinence; Remote Consultation; Videoconferencing; Women's Health; Menopause

Keywords

Women's Health; Hospitals, Veterans; Education; Remote consultation; Videoconferencing

Outcome Measures

Primary Outcomes (1)

• Change in Quality of Women's Health Care (Control Period vs. Intervention Period)

  Quality of care as defined by adherence to practice guidelines. This measure is the difference in the percent of applicable quality indicators for whom the guideline adherent action was performed by primary care providers at baseline versus after entering into the intervention.

  Baseline through four months after the final time step when participants entered into the intervention (28 months)

Secondary Outcomes (5)

• Change in Quality of Women's Health Care (Controlled Trial Steps)

  Baseline through four months after the final time step when participants entered into the intervention (28 months)

• Provider Referral Behavior

  1-7 days after receiving a response to the electronic consult

• Quality of Abnormal Uterine Bleeding Care

  28-month study timeframe

• Quality of Menopausal Symptoms Care

  28-month study timeframe

• Quality of Urinary Incontinence Care

  28-month study timeframe

Study Arms (3)

Stepped wedge participants

Designated Women's Health Providers with one or more episodes of care for women patients during each period of the intervention. Designated Women's Health Provider: Primary care provider who are proficient in women's health, and should have a minimum of 10% of their patient panels being comprised by women.

Other: Clinical innovation

Electronic consultation survey participants

Designated Women's Health Providers who completed surveys about use of electronic consultations. Designated Women's Health Provider: Primary care provider who are proficient in women's health, and should have a minimum of 10% of their patient panels being comprised by women.

Other: Clinical innovation

Quality assessment participants

Primary care providers delivering women's health care for one or more of the following conditions: abnormal uterine bleeding; menopausal symptoms; urinary incontinence.

Other: Clinical innovation

Interventions

Clinical innovation OTHER

Technology-based intervention that combines interactive communication with women's health specialists and ongoing education

Also known as: "DWHP Support"

Electronic consultation survey participants; Quality assessment participants; Stepped wedge participants

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

VA Women's Health primary care provider in who participates in VA SCAN-ECHO learning sessions or uses VA gynecology electronic consults.

You may qualify if:

• US Department of Veterans Affairs Women's Health primary care provider in who participates in Veterans Affairs SCAN-ECHO learning sessions or uses Veterans Affairs gynecology electronic consults.

You may not qualify if:

• none

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

West Los Angeles, California, 90073, United States

Location

Related Publications (7)

• Cordasco KM, Zuchowski JL, Hamilton AB, Kirsh S, Veet L, Saavedra JO, Altman L, Knapp H, Canning M, Washington DL. Early lessons learned in implementing a women's health educational and virtual consultation program in VA. Med Care. 2015 Apr;53(4 Suppl 1):S88-92. doi: 10.1097/MLR.0000000000000313.

  PMID: 25767983 RESULT

• deKleijn M, Lagro-Janssen AL, Canelo I, Yano EM. Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel. Med Care. 2015 Apr;53(4 Suppl 1):S156-64. doi: 10.1097/MLR.0000000000000307.

  PMID: 25767971 RESULT

• Yano EM. A partnered research initiative to accelerate implementation of comprehensive care for women veterans: the VA women's health CREATE. Med Care. 2015 Apr;53(4 Suppl 1):S10-4. doi: 10.1097/MLR.0000000000000340. No abstract available.

  PMID: 25767962 RESULT

• Zuchowski JL, Hamilton AB, Washington DL, Gomez AG, Veet L, Cordasco KM. Drivers of Continuing Education Learning Preferences for Veterans Affairs Women's Health Primary Care Providers. J Contin Educ Health Prof. 2017 Summer;37(3):168-172. doi: 10.1097/CEH.0000000000000164.

  PMID: 28817394 RESULT

• Washington DL, Danz M, Jackson L, Cordasco KM. Development of Quality Indicators for the Care of Women with Abnormal Uterine Bleeding by Primary Care Providers in the Veterans Health Administration. Womens Health Issues. 2019 Mar-Apr;29(2):135-143. doi: 10.1016/j.whi.2018.11.002. Epub 2018 Dec 15.

  PMID: 30563732 RESULT

• Cordasco KM, Yuan AH, Danz MJ, Farmer MM, Jackson L, Yee EF, Washington DL. Guideline Adherence of Veterans Health Administration Primary Care for Abnormal Uterine Bleeding. Womens Health Issues. 2019 Mar-Apr;29(2):144-152. doi: 10.1016/j.whi.2018.12.004. Epub 2019 Feb 2.

  PMID: 30723059 RESULT

• Cordasco KM, Yuan AH, Danz MJ, Jackson L, Yee EF, Tcheung LS, Washington DL. Veterans Health Administration Primary Care Provider Adherence to Prescribing Guidelines for Systemic Hormone Therapy in Menopausal Women. J Healthc Qual. 2019 Mar/Apr;41(2):99-109. doi: 10.1097/JHQ.0000000000000183.

  PMID: 30839493 RESULT

Biospecimen

Retention: NONE RETAINED

Not applicable - none

MeSH Terms

Conditions

Metrorrhagia; Urinary Incontinence

Condition Hierarchy (Ancestors)

Uterine Hemorrhage; Uterine Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Diseases; Hemorrhage; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Urination Disorders; Urologic Diseases; Male Urogenital Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Signs and Symptoms

Results Point of Contact

• Title: Donna L. Washington, MD, MPH
• Organization: VA Greater Los Angeles Healthcare System, West Los Angeles, CA

donna.washington@va.gov

310-478-3711

Study Officials

• Donna L Washington, MD MPH

  VA Greater Los Angeles Healthcare System, West Los Angeles, CA

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: ECOLOGIC OR COMMUNITY
• Time Perspective: RETROSPECTIVE
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 16, 2013
• First Posted: August 7, 2013
• Study Start: March 1, 2013
• Primary Completion: September 30, 2018
• Study Completion: September 30, 2018
• Last Updated: November 4, 2019
• Results First Posted: November 4, 2019

Record last verified: 2019-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)