- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00414986
Using Learning Teams for Reflective Adaptation for Diabetes and Depression (ULTRA-DM/MDD)
November 21, 2012 updated by: University of Colorado, Denver
Using Learning Teams for Reflective Adaptation
The study will randomize 54 primary care practices to two intervention and a comparison groups.
Both interventions will involve an on-site Improvement Facilitator who will assist the practice in forming an Improvement Team, using rapid-cycle tests of change, and implementing chronic care office systems for type 2 diabetes and depression.
One intervention is based on complexity science and the other is a traditional QI intervention.
Study Overview
Status
Completed
Conditions
Detailed Description
Evidence-based guidelines for primary care of diabetes have been established and disseminated, yet adoption of guidelines in community-based primary care practice has been disappointing.
This effectiveness study proposes a randomized trial involving 54 community-based primary care practices to test two innovative interventions to improve diabetes and depression care.
One intervention, derived from theoretically based and efficacious programs tested in other settings, adopts a broad focus and seeks to improve diabetes and depression care by a) increasing the practice's organizational capacity to manage change, and b) implementing and sustaining chronic care office systems that support clinician efforts to improve care for diabetes.
The intervention will combine two integrated components.
The first component will utilize an Improvement Facilitator that will assess the practice's current use of chronic care office systems and their organizational capacity to manage change, provide feedback to key stakeholders in the practice, and work with the practice over six months to form an Improvement Team that will both address organizational capacity to create and sustain improvement and implement chronic care systems.
In the second component of the intervention, the practice will participate in a local Improvement Collaborative that will afford opportunities to learn and share experiences during implementation and maintenance phases of the intervention with five similar practices in their geographic area.
The second intervention is based on traditional QI methods and focuses on a chronic disease registry with regular reports to the physicians.
It also uses PDSA cycles to assist in implementing change.
This intervention will offer tools to improve diabetes and/or asthma care.
Both interventions will be evaluated in two ways.
First, a randomized trial using rigorous quantitative methods will measure 2 primary and 3 secondary endpoints at 9 and 18 months, including a) the ADA Physician Recognition Program performance measures by both patient-report and review of the medical record, and b) HEDIS measures of acute phase management of depression, c) assessment of the extent to which practices implement and physicians use elements of the chronic care model in their care of diabetes and depression.
Change from baseline to 9 months will assess adoption of chronic care improvements, and change from 9 to 18 months will assess sustainability of improvements.
Second, a multimethod assessment process will be used to analyze all qualitative and quantitative data separately to understand how and why the intervention led to the observed effects.
The practice assessment will strive to understand which components of the interventions were most effective, their relative costs for implementation, and how they might be further improved.
Successful components of the intervention will be refined and made available to our collaborators in the project; the Copic Insurance Company and the Colorado Clinical Guidelines Collaborative, for use in their statewide activities to improve diabetes care.
Study Type
Interventional
Enrollment (Actual)
1565
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Colorado
-
Denver, Colorado, United States, 80045
- University of Colorado Health Sciences Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Under primary care for type 2 diabetes
Exclusion Criteria:
- Are not minimally literate in either English or Spanish
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 1
Practice in this arm will receive the Chronic Care Improvement intervention
|
An in-practice change facilitator will assist the Improvement Team in enhancing the relationship infrastructure of the practice and in implementing diabetes and depression office systems.
|
Experimental: 2
Practices in this arm will receive the standard CQI intervention.
An in-practice CQI coordinator will assist the practices in implement a chronic disease registry.
|
In-practice change facilitator assists the practice in implementing a chronic disease registry
|
Active Comparator: 3
Practice in this arm will have access to all chronic care tools, but will not have an in-practice change agent.
|
Practices will have access to all tools used in Arm 1 via a project website
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Surveillance of Hemoglobin A1c, blood pressure, lipids, depression process of care
Time Frame: Baseline, 9, and 18 month
|
Baseline, 9, and 18 month
|
HEDIS-like measures of acute phase management of depression
Time Frame: Baseline, 9, and 18 months
|
Baseline, 9, and 18 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Patient report (by survey) of their primary care experience
Time Frame: baseline, 9-months, 18-months
|
baseline, 9-months, 18-months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: David West, PhD, Department of Family Medicine, University of Colorado Health Sciences Center
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
September 1, 2005
Primary Completion (Actual)
February 1, 2012
Study Completion (Actual)
February 1, 2012
Study Registration Dates
First Submitted
December 21, 2006
First Submitted That Met QC Criteria
December 21, 2006
First Posted (Estimate)
December 22, 2006
Study Record Updates
Last Update Posted (Estimate)
November 22, 2012
Last Update Submitted That Met QC Criteria
November 21, 2012
Last Verified
November 1, 2012
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 05-0457
- R18DK067083 (U.S. NIH Grant/Contract)
- MH069806
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.
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