Telehealth-delivered Peer Support to Improve Quality of Life Among Veterans With Multimorbidity

NCT05560451 | Active Not Recruiting

• 1 other identifier: IIR 21-100
• Study Type: interventional
• Target: 298
• Locations: 1 country
• Sites: 1

Brief Summary

The VetASSIST study is a randomized clinical trial testing whether receiving virtual health coaching from Veteran peers improves the physical and mental health-related quality of life of Veterans with multiple chronic health conditions and complex healthcare needs. VetASSIST will test the efficacy of an intervention that matches Veteran patients with multimorbidty with Veteran health coaches who will provide education, resources, guidance and support to help them manage their physical and mental health over the course of a year.

Conditions

Multimorbidity

Keywords

Peer health coaching; Health-related quality of life; Veterans; Multimorbidity; Self-management; Social support; Multiple chronic conditions; Telemedicine

Outcome Measures

Primary Outcomes (1)

• Change in physical health related quality of life (HRQoL)

  12 Item Short Form Health Survey (SF-12) Physical Component Summary: Summary scores for general health, physical functioning, role-physical, and bodily pain. Scaling scores will be assessed using published standardized scoring system procedures for the SF-12 found at: www.researchgate.net/publication/242636950\_SF-12\_How\_to\_Score\_the\_SF-12\_Physical\_and\_Mental\_Health\_Summary\_Scales

  Baseline to 12-months

Secondary Outcomes (2)

• Change in mental health quality of life (HRQoL)

  Baseline to 12-months

• Health care utilization

  Baseline to 12-months

Other Outcomes (9)

• Patient activation

  Baseline to 12-months

• Social support

  Baseline to 12-months

• Shared decision-making

  Baseline to 12-months

Study Arms (2)

Peer health coach intervention

EXPERIMENTAL

Participants will receive 20 virtual visits with a trained Veteran peer health coach over 12 months. Coaches will provide participants with brief health education, assist with goal setting and problem solving, enhance social support, and link participants to VA and community resources.

Behavioral: Peer health coach intervention

Control group/no intervention

NO INTERVENTION

Participants will continue to receive their regular, usual primary care.

Interventions

Peer health coach intervention BEHAVIORAL

Eligible participants will be randomly assigned to receive a telehealth delivered peer health coach intervention to promote health outcomes and behavior change among Veterans with multimorbidty.

Also known as: VetASSIST

Peer health coach intervention

Eligibility Criteria

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

You may qualify if:

• Veteran patient receiving primary care from VA Puget Sound
• Complex multimorbidity (\>=3 chronic conditions in \>=3 body systems based on AHRQ Chronic Condition Index)
• Meets \>=2 criterion from NICE multimorbidity guidelines: 1) have a chronic physical and mental health condition (via ICD-10 codes in Corporate Data Warehouse (CDW) and the CCI); 2) frailty (determined by the JEN Frailty Index available in VA data, confirmed via self-reported PRISMA-7 during the eligibility screening; 3) frequent emergency care (\>=1 VA emergency department visit in past year via CDW); 4) polypharmacy (\>=10 prescribed medications via CDW, or 5) significant treatment burden (score \>22 on the self-reported Multimorbidity Treatment Burden Questionnaire at study screening)
• Agree to participate in the health coaching sessions and surveys if assigned to intervention group

You may not qualify if:

• Not fluent in English
• Severe hearing loss
• No phone access and/or missing phone number
• Missing address
• Diagnosis of dementia or severe cognitive impairment within last year
• Diagnosis of end stage renal disease or on dialysis within last year
• Receipt of palliative or hospice care in the past year
• Receipt of nursing home care in past year (Stop codes: 650, 651,119,121)
• Currently living in a nursing home, skilled nursing facility, rehabilitation facility, or long-term care facility
• Behavior flags in EHR
• Active treatment for non-melanoma skin cancer diagnosis
• Diagnosis of substance use dependence/abuse disorder in last year (excluding tobacco)
• Diagnosis of psychotic disorder in last year
• Pregnant or planning to become pregnant in next 6 months
• Score of \>8 (severe risk) on self-reported Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions on eligibility screen

Sponsors & Collaborators

• VA Office of Research and Development: lead

Study Sites (1)

VA Puget Sound Health Care System Seattle Division, Seattle, WA

Seattle, Washington, 98108-1532, United States

Location

Related Publications (2)

• Kramer CB, Nelson KM, Sayre G, Williams JL, Spruill L, Fennell T, Gray KE, Weiner BJ, Fan V, Jones-Smith J, Rao M. "Veteran to Veteran, There's Automatically a Trust": A Qualitative Study of Veterans' Experiences in a Peer Health-Coaching Program for Hypertension. AJPM Focus. 2024 Jul 3;3(6):100257. doi: 10.1016/j.focus.2024.100257. eCollection 2024 Dec.

  PMID: 39415799 RESULT

• Gray KE, Williams JL, Rivera-Remines A, Fennell T, Rao M, Rogers T, Taylor L, Nelson KM, Hoerster KD. Protocol for VetASSIST: A randomized controlled trial to evaluate virtual peer health coaching for veterans with multimorbidity. Contemp Clin Trials. 2025 Oct;157:108045. doi: 10.1016/j.cct.2025.108045. Epub 2025 Aug 14.

  PMID: 40818733 RESULT

MeSH Terms

Conditions

Multiple Chronic Conditions

Condition Hierarchy (Ancestors)

Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Kristen E. Gray, PhD MS BS

  VA Puget Sound Health Care System Seattle Division, Seattle, WA

  PRINCIPAL INVESTIGATOR

• Katherine D Hoerster, PhD MPH BA

  VA Puget Sound Health Care System Seattle Division, Seattle, WA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Concealment will be used to prevent the study staff from obtaining information on the sequence of assignment. Because of the nature of the intervention, the investigators are unable to blind participants and staff to treatment assignment. Staff who complete outcomes assessment are masked to study assignment.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Model Details: Hybrid type 1 trial with 294 Veterans with multimorbidity. Participants will be randomized to one of two groups -- the control or intervention group -- in parallel for the duration of the study.

Study Record Dates

• First Submitted: September 26, 2022
• First Posted: September 29, 2022
• Study Start: October 19, 2023
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): June 30, 2027
• Last Updated: September 14, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)