Aligning Patients and Their Primary Care Providers

NCT02707146 | Completed Results

• 1 other identifier: CN-14-2070-H
• Study Type: interventional
• Target: 750
• Locations: 1 country
• Sites: 1

Brief Summary

This project focuses on improving the patient-provider primary care visit interaction by addressing the need to align patient and provider priorities in a way that incorporates patients' goals and preferences while supporting the clinical work of their providers.

Conditions

Primary Health Care; Quality of Health Care; Comorbidity; Communication; Medical Informatics Applications

Outcome Measures

Primary Outcomes (1)

• Aggregate Measure of Guideline-Based Clinical Care Gaps

  All patients enrolled in the study will have one or more guideline-based care gaps at baseline. Care gaps are defined as: overdue for cancer screening (mammography, colorectal cancer), overdue for chronic disease monitoring (blood pressure, HbA1c), above goal for chronic disease (SBP \> 140, HbA1c \> 8%), or medication related (not prescribed a statin if clinically indicated, not prescribed medicine for osteoporosis if indicated, \< 80% adherence to medication for diabetes, hypertension, or hyperlipidemia), or current smoker. The investigators will assess % of patients resolving baseline clinical care gaps after 12 months. The aggregate outcome will be defined as yes/no resolution of baseline care gap. The study arms will be compared using an aggregate measure of these guideline-based clinical care gaps.

  12 months

Secondary Outcomes (1)

• Patient-reported Outcomes

  Within 1 week of primary care study visit

Study Arms (2)

Tablet in the waiting room

EXPERIMENTAL

Patients in the intervention arm will be met in the waiting room prior to their primary care visit and will use the "Visit Planner" tool application on the tablet

Behavioral: Visit Planner; Device: iPad

Health Education Handout

ACTIVE COMPARATOR

Patients in the control arm will be met in the waiting room prior to their primary care visit and will be given an educational pamphlet on health lifestyle to review

Other: Attention Control Pamphlet

Interventions

Visit Planner BEHAVIORAL

The Visit Planner is an application hosted on an iPad that guides the patient in preparing for the primary care visit

Tablet in the waiting room

Attention Control Pamphlet OTHER

Patients in the attention control arm will receive an approved educational handout on health lifestyle

Health Education Handout

iPad DEVICE

Tablet in the waiting room

Eligibility Criteria

• Age: 30 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Kaiser Permanente member with an assigned primary care provider, with at least one quality care gap at baseline (overdue screening tests, elevated risk factor levels, sub-optimal adherence to chronically prescribed medicines, current smoker)
• Patients must be either:
• \) relatively new to their provider (0-3 visits in past 18 months) or if associated with their provider for \> 18 months,
• \) have evidence for medical complexity (4 or more prescribed medicines, in a chronic disease management program, or recently admitted to hospital or emergency department)

You may not qualify if:

• Excluded by their primary care provider

Sponsors & Collaborators

• Kaiser Permanente: lead
• Patient-Centered Outcomes Research Institute: collaborator

Study Sites (1)

Oakland Medical Center

Oakland, California, 94610, United States

Location

Related Publications (5)

• Grant RW, Lyles C, Uratsu CS, Vo MT, Bayliss EA, Heisler M. Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial. Ann Fam Med. 2019 Mar;17(2):141-149. doi: 10.1370/afm.2352.

  PMID: 30858257 RESULT

• Kowalski CP, McQuillan DB, Chawla N, Lyles C, Altschuler A, Uratsu CS, Bayliss EA, Heisler M, Grant RW. 'The Hand on the Doorknob': Visit Agenda Setting by Complex Patients and Their Primary Care Physicians. J Am Board Fam Med. 2018 Jan-Feb;31(1):29-37. doi: 10.3122/jabfm.2018.01.170167.

  PMID: 29330237 RESULT

• Lyles CR, Altschuler A, Chawla N, Kowalski C, McQuillan D, Bayliss E, Heisler M, Grant RW. User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits. JMIR Mhealth Uhealth. 2016 Sep 14;4(3):e108. doi: 10.2196/mhealth.6187.

  PMID: 27627965 RESULT

• Ruvalcaba D, Nagao Peck H, Lyles C, Uratsu CS, Escobar PR, Grant RW. Translating/Creating a Culturally Responsive Spanish-Language Mobile App for Visit Preparation: Case Study of "Trans-Creation". JMIR Mhealth Uhealth. 2019 Apr 5;7(4):e12457. doi: 10.2196/12457.

  PMID: 30950803 RESULT

• Santo EC, Vo MT, Uratsu CS, Grant RW. Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns. J Am Board Fam Med. 2019 Jul-Aug;32(4):513-520. doi: 10.3122/jabfm.2019.04.180380.

  PMID: 31300571 DERIVED

MeSH Terms

Conditions

Communication

Condition Hierarchy (Ancestors)

Behavior

Results Point of Contact

• Title: Dr. Richard Grant
• Organization: Division of Research, Kaiser Permanente Northern California

Richard.W.Grant@kp.org

510-891-5993

Study Officials

• Richard W Grant, MD MPH

  Division of Research, KPNC

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 4, 2016
• First Posted: March 14, 2016
• Study Start: March 1, 2016
• Primary Completion: July 1, 2017
• Study Completion: December 1, 2018
• Last Updated: April 30, 2019
• Results First Posted: April 30, 2019

Record last verified: 2019-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)