- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00119054
Effectiveness of Home-Based Health Messaging for Patients With Hypertension and Diabetes
Effectiveness of Care Coordination in Managing Medically Complex Patients
Patients treated at Veterans Affairs (VA) medical centers are older and have multiple chronic conditions. Two of the most common conditions in the VA population are hypertension (HTN) and Type 2 diabetes (DM). Unfortunately, DM and HTN have few perceptible symptoms on a daily basis that motivate patients to comply with treatment recommendations and lifestyle changes. Thus, serious complications and long-term adverse outcomes are common in both of these conditions.
Home telehealth is a general term used to describe the delivery of health care services to the patient's home using audio, video, or other telecommunications technologies. Although home telehealth offers a number of theoretical advantages, few well-designed controlled clinical trials have been conducted to establish efficacy and cost benefit. Furthermore, projects to date have focused on special populations, e.g., heart failure or mental illnesses. Since home telehealth may hold the most promise for individuals dealing with multiple chronic illnesses, there is a need for population-based studies addressing the needs of patients in primary care settings.
Care coordination, as defined by the VHA Office of Care Coordination, is a process of assessment and ongoing monitoring of patients using home telehealth to proactively enable prevention, investigation, and treatment that enhances the health of patients and prevents unnecessary and inappropriate use of resources. Care coordination embeds technology into a care management process. This results in the right care, at the right time, in the right place.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Patients treated at Veterans Affairs (VA) medical centers are older and have multiple chronic conditions. Two of the most common conditions in the VA population are hypertension (HTN) and Type 2 diabetes (DM). Unfortunately, DM and HTN have few perceptible symptoms on a daily basis that motivate patients to comply with treatment recommendations and lifestyle changes. Thus, serious complications and long-term adverse outcomes are common in both of these conditions.
Home telehealth is a general term used to describe the delivery of health care services to the patient's home using audio, video, or other telecommunications technologies. Although home telehealth offers a number of theoretical advantages, few well-designed controlled clinical trials have been conducted to establish efficacy and cost benefit. Furthermore, projects to date have focused on special populations, e.g., heart failure or mental illnesses. Since home telehealth may hold the most promise for individuals dealing with multiple chronic illnesses, there is a need for population-based studies addressing the needs of patients in primary care settings.
Care coordination, as defined by the VHA Office of Care Coordination, is a process of assessment and ongoing monitoring of patients using home telehealth to proactively enable prevention, investigation, and treatment that enhances the health of patients and prevents unnecessary and inappropriate use of resources. Care coordination embeds technology into a care management process. This results in the right care, at the right time, in the right place.The primary objective of the proposed study is to evaluate the efficacy of care coordination in improving outcomes in veterans with co-morbid DM and HTN, the two most common chronic conditions seen in VA Primary Care clinics. The specific aim is to compare outcomes of patients who receive the care coordination intervention to outcomes of patients who receive usual care. Three hypotheses will be tested: Compared to subjects who receive usual care, subjects who receive the care coordination intervention will have: 1) improved clinical measures [hemoglobin A1c (HbA1c) and systolic blood pressure (SBP)] at 6 and 12 months after study enrollment; 2) improved disease self-management (knowledge, self-efficacy, and adherence) at 6 and 12 months after study enrollment; and 3) improved quality of life and satisfaction with care at 6 and 12 months after study enrollment.Subjects wererecruited from VA Primary Care clinic rolls. 302 subjects were randomized to three groups: low-intensity monitoring plus nurse care management intervention (n=102); high-intensity monitoring plus nurse care management intervention (n=93); and usual care (n=107). In both intervention groups patients transmitted vital signs daily. In addition, the low intensity group answered two general health questions; the high intensity group responded to a complete range of questions focused on diabetes and hypertension, and received educational tips. The intervention groups participated in the protocol for 6 months following enrollment. Data were collected at baseline and at 6 and 12 months, including measures of clinical outcomes, quality of life, knowledge, adherence, self-efficacy, and satisfaction with care. In addition to these measures, data were collected to estimate the cost of the home telehealth intervention. Most subjects were male (98%) Caucasians (96%) with a mean age of 68 years (range 40-89 years).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Iowa
-
Iowa City, Iowa, United States, 52246-2208
- Iowa City VA Health Care System, Iowa City, IA
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Patients must obtain their primary care at the Iowa City VAMC and have been diagnosed with Diabetes Mellitus and hypertension. Must be cognitively intact and have a telephone line in the home.
Exclusion Criteria:
Patients with corrected vision worse than 20/40 or cognitive impairment (Mini-Mental Status Exam score of 17 or less) will not be eligible.
Study Plan
How is the study designed?
Design Details
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Arm 1
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
---|
Blood Pressure and Hemaglobin A1c
|
Secondary Outcome Measures
Outcome Measure |
---|
Knowledge Compliance Self-efficacy Quality of life Satisfaction with care
|
Collaborators and Investigators
Investigators
- Principal Investigator: Bonnie J. Wakefield, PhD RN, Iowa City VA Health Care System, Iowa City, IA
Publications and helpful links
General Publications
- Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hills SL, Rosenthal GE. Outcomes of a home telehealth intervention for patients with diabetes and hypertension. Telemed J E Health. 2012 Oct;18(8):575-9. doi: 10.1089/tmj.2011.0237. Epub 2012 Aug 8.
- Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hillis SL, Rosenthal GE. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Telemed J E Health. 2011 May;17(4):254-61. doi: 10.1089/tmj.2010.0176. Epub 2011 Apr 10.
- Wakefield BJ, Holman JE, Ray A, Scherubel M. Patient perceptions of a remote monitoring intervention for chronic disease management. J Gerontol Nurs. 2011 Apr;37(4):16-20. doi: 10.3928/00989134-20110302-05. Epub 2011 Mar 16.
- Young LB, Foster L, Silander A, Wakefield BJ. Home telehealth: patient satisfaction, program functions, and challenges for the care coordinator. J Gerontol Nurs. 2011 Nov;37(11):38-46. doi: 10.3928/00989134-20110706-02. Epub 2011 Jul 15.
- Wakefield BJ, Scherubel M, Ray A, Holman JE. Nursing interventions in a telemonitoring program. Telemed J E Health. 2013 Mar;19(3):160-5. doi: 10.1089/tmj.2012.0098. Epub 2013 Jan 28.
- Gardner SE, Hillis SL, Frantz RA. Clinical signs of infection in diabetic foot ulcers with high microbial load. Biol Res Nurs. 2009 Oct;11(2):119-28. doi: 10.1177/1099800408326169.
- Boren SA, Wakefield BJ, Dohrmann M. Chronic heart failure consumer information: an exploratory study. AMIA Annu Symp Proc. 2008 Nov 6:884.
- Wakefield BJ, Mentes J, Holman JE, Culp K. Postadmission dehydration: risk factors, indicators, and outcomes. Rehabil Nurs. 2009 Sep-Oct;34(5):209-16. doi: 10.1002/j.2048-7940.2009.tb00281.x.
- Rantz MJ, Skubic M, Alexander G, Popescu M, Aud MA, Wakefield BJ, Koopman RJ, Miller SJ. Developing a comprehensive electronic health record to enhance nursing care coordination, use of technology, and research. J Gerontol Nurs. 2010 Jan;36(1):13-7. doi: 10.3928/00989134-20091204-02. Epub 2010 Jan 12.
Study record dates
Study Major Dates
Study Start
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NRI 03-312
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Hypertension
-
National Taiwan University Hospital Hsin-Chu BranchRecruitingHypertension,Essential | Hypertension, MaskedTaiwan
-
University of Alabama at BirminghamTroy UniversityCompletedHypertension | Hypertension, Resistant to Conventional Therapy | Uncontrolled Hypertension | Hypertension, White CoatUnited States
-
BayerCompletedPrimary HypertensionChina
-
Columbia UniversityAgency for Healthcare Research and Quality (AHRQ)Active, not recruitingWhite Coat Hypertension | Hypertension,EssentialUnited States
-
Addpharma Inc.Completed
-
Universidade Federal de Santa MariaCompletedHealthy Volunteers | Hypertension, EssentialBrazil
-
Sheffield Teaching Hospitals NHS Foundation TrustUniversity of SheffieldCompletedIdiopathic Pulmonary Arterial Hypertension | Chronic Thromboembolic Pulmonary HypertensionUnited Kingdom
-
China Academy of Chinese Medical SciencesGuang'anmen Hospital of China Academy of Chinese Medical SciencesCompletedHypertension, Resistant to Conventional Therapy | Primary HypertensionChina
-
Cytos Biotechnology AGCompletedMild Essential Hypertension | Moderate Essential HypertensionSwitzerland
Clinical Trials on In Home Health Messaging Device
-
US Department of Veterans AffairsCompletedCerebrovascular AccidentUnited States
-
University of UtahCompletedHigh Risk PregnancyUnited States
-
Boston UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development... and other collaboratorsRecruitingBreastfeeding | SUID | SIDSUnited States
-
Boston Children's HospitalCenters for Disease Control and PreventionCompletedInfluenzaUnited States
-
University of California, Los AngelesW.K. Kellogg Foundation; Center for HIV Identification, Prevention, and Treatment...CompletedPregnant Women | Breast Feeding | Newborns | Nutrition During PregnancyUnited States
-
Memorial Sloan Kettering Cancer CenterActive, not recruitingImproving Blood Pressure ControlUnited States
-
TruDiagnosticBlushield USANot yet recruitingAging | Aging Well
-
The University of Hong KongHaven of Hope Hospital; The Social Innovation and Entrepreneurship Development...CompletedTechnologyHong Kong
-
Washington University School of MedicineRecruitingObesity | Overweight | Severe Mental DisorderUnited States
-
Kaiser PermanenteCompleted