Pilot Study to Improve Care Coordination

NCT02386189 | Completed Results

• 1 other identifier: SDR 14-392
• Study Type: interventional
• Target: 63
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is 1) to learn how VA patients can help share their health information between their VA providers and providers outside the VA and 2) if sharing this information is useful to providers and improves care received.

Conditions

Chronic Illness

Keywords

Continuity of Patient Care; Health Records, Personal; Veterans; Patient Participation; Chronic Disease

Outcome Measures

Primary Outcomes (3)

• Patient Perceived Continuity of Care From Multiple Providers- Management Continuity

  Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Management continuity refers to the patient being able to identify one provider who is the main coordinator and assures all the links within the health care team. The possible range on this measure was between 5 and 40 and the analysis was conducted on the pre-post difference on Management Continuity, subtracting the baseline score from the post-intervention score. More positive score indicated greater perceived management continuity and greater improvement in perceived management continuity.

  The time frame is from baseline assessment to 12 months post baseline during which at least one VA and one Community medical visit occurred.

• Patient Perceived Continuity of Care From Multiple Clinicians - Informational Continuity

  Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Informational Continuity refers to whether patients experienced communication failures between providers. The possible range on this measure was between 12 and 36. The analysis was conducted on the pre-post difference on Informational Continuity, subtracting the baseline score from the post-intervention score. For this measure a lower score and a decline between post intervention and baseline scores (or a negative value) indicates more positive outcomes.

  Baseline to 12-month follow-up

• Patient Perceived Continuity of Care From Multiple Clinicians- Role Continuity

  Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Role Continuity refers to the role of all clinicians being clear to the patient and to the providers on the treatment team. The possible range on this measure was between 6 and 30, and the analysis was conducted on the pre-post difference on this measure. More positive score indicated greater perceived role clarity and, when comparing pre and post score, a more positive score indicated greater improvement in perceived role clarity.

  Baseline to 12-month follow-up

Secondary Outcomes (4)

• Number of Participants With Duplication of Laboratory Tests

  Baseline assessment to 12 months post-baseline, where a laboratory duplication is only counted if the medical visits occurred within three months of each other.

• Proportion of Medication Concordance

  Time frame between two medical visits occuring within the one year study period

• Relational Coordination- VA Providers

  Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.

• Relational Coordination Community Providers

  Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.

Study Arms (2)

Usual Care

NO INTERVENTION

Veterans randomized to usual care will not receive any training on using their patient portal(s) to access and share information. They will be contacted via phone and/or secure messaging to remind him/her to take the VA or non-VA provider packet to their appointment. At the conclusion of the study, Veterans assigned to usual care will be provided the training information on the VA health summary for their own reference.

Care Coordination

ACTIVE COMPARATOR

Veterans in this group will share a comprehensive list of all of their providers (VA and non-VA) at future appointments. He/she will also be trained on how to create a VA Health Summary in My HealtheVet to share with their non-VA providers and how to use their community portals (if available) to share information back to VA providers. A VA and non-VA provider visit will be evaluated.

Behavioral: Patient Care Coordination Training

Interventions

Patient Care Coordination Training BEHAVIORAL

Veterans in this group will share a comprehensive list of all of their providers (VA and non-VA) at future appointments. He/she will also be trained on how to create a VA Health Summary in My HealtheVet to share with their non-VA providers and how to use their community portals (if available) to share information back to VA providers. A VA and non-VA provider visit will be evaluated.

Care Coordination

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• VA Patient
• Receives health care from VA and non-VA provider
• Diagnosed with a chronic health condition
• Prescribed 5 or more medications
• Upcoming VA and non-VA appointments within the study time frame
• Registered or willing to become registered with My HealtheVet
• Access to a computer with internet, phone, and a printer.
• English speaking
• VA or Non-VA Providers: provide care to a stuy participant

You may not qualify if:

• Previously shared health data with a provider via their My HealtheVet or local provider patient portal
• No scheduled VA or non-VA appointments

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

Iowa City VA Health Care System, Iowa City, IA

Iowa City, Iowa, 52246-2208, United States

Location

Related Publications (2)

• Haggerty JL, Roberge D, Freeman GK, Beaulieu C, Breton M. Validation of a generic measure of continuity of care: when patients encounter several clinicians. Ann Fam Med. 2012 Sep-Oct;10(5):443-51. doi: 10.1370/afm.1378.

  PMID: 22966108 BACKGROUND

• Manski-Nankervis JA, Blackberry I, Young D, O'Neal D, Patterson E, Furler J. Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. BMC Health Serv Res. 2014 Nov 1;14:515. doi: 10.1186/s12913-014-0515-3.

  PMID: 25361788 BACKGROUND

MeSH Terms

Conditions

Chronic Disease; Patient Participation

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Limitations and Caveats

The main limitation is that this is a pilot study and thus has a small sample size. Another limitation is the poor response rate from providers.

Results Point of Contact

• Title: Dr. Carolyn Turvey
• Organization: Iowa City VA Health Care System

carolyn.turvey@va.gov

319 358 9501

Study Officials

• Carolyn L Turvey, PhD MS

  Iowa City VA Health Care System, Iowa City, IA

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: For one of the outcomes (laboratory duplication) the assessor is blind to group assignment.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 11, 2015
• First Posted: March 11, 2015
• Study Start: March 2, 2015
• Primary Completion: March 1, 2017
• Study Completion: March 31, 2017
• Last Updated: August 28, 2019
• Results First Posted: July 30, 2019

Record last verified: 2019-08

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)