Assessing the Effectiveness of Concurrent Peer Review for Patients With Cardiovascular Disease and Diabetes

Concurrent Peer Review Visits to Reduce Cardiovascular Risk Factors

We will assess the impact of concurrent peer review vists on blood pressure, cholesterol and diabetes control. Concurrent peer review (CPR) visits refer to special offic visits by patients to a clinician (physician, nurse practitioner, or physician assistant) other than than their primary care provider that are specifically designed to improve care for diabetes and cardiovascular disease.

Study Overview

• Status: Completed
• Conditions: Cardiovascular Diseases
• Intervention / Treatment: Other: Usual Care; Behavioral: Concurrent Peer Review visit

Detailed Description

This project aims to reduce racial and ethnic disparities in health care by improving cardiovascular and diabetes management among poor and minority patients. We propose to implement and evaluate an innovative, but practical intervention: CPR visits. CPR visits are designed to minimize competing demands for clinicians and reduce clinical inertia by focusing clinician and patient attention on optimizing cardiovascular and/or diabetes management and disease control and through use of clinician prompts and decision support at the point of care. Following training of clinician staff, CPR visits will be implemented within two sites of a single community health center (Westside Health Services, Inc). Patients will be randomly assigned one CPR visit with a clinician other than their primary care clinician or to usual care. The primary study outcome will include control of hypertension, diabetes, and lipids. Secondary outcomes will include process measures for cardiovascular and diabetes care. Both personnel and data collection infrastructure will build on the existing Health Disparities Collaborative at Westside. A research team from the University of Rochester will assist in the implementation of study design. This team will lead both the quantitative and qualitative evaluation of the project including outcome and process measures. Project findings offer promise for improving care to underserved populations through dissemination and implementation of a feasible strategy among practices caring for the underserved. Findings will be disseminated nationally in conjunction with the Robert Wood Johnson Foundation, the National Association of Community Health Centers, and the National Health Disparities Collaborative and through publication in the peer reviewed literature and presentation at national conferences.

• Study Type: Interventional
• Enrollment (Actual): 727
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • Rochester, New York, United States, 14611
      • Westside Health Services, Inc

Participation Criteria

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:

• Active patient at Westside Health Services.
• Currently enrolled in the Health Disparities Collaborative at WHS.
• At least one visit to primary care provider in past year.
• Any of the following documented during the preceding three months:
• BP not at goal e,g. (BP 140/80 or greater unless has DM, CAD or CRI then BP greater than 130/80), LDL-C not at goal (level dependent on absolute ATP III CVD risk) or glycated hemoglogin 7 percent or higher

Exclusion Criteria:

• Less than 18 years of age

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; usual care	Other: Usual Care; Usual Care with primary care provider during time period
Experimental: Concurrent Peer Review Visit; See description of interventioin	Behavioral: Concurrent Peer Review visit; Participants are offered an office visit with a peer of their clinician primary clinician. This office visit is structured and focused on blood pressure, diabetic, and/or lipid control with decision support available at point of care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Mean change in blood pressure, glycated hemoglobin, and LDL-cholesterol between baseline and follow-up	7 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Use of aspirin, ACE inhibiters/ARBs (diabetic patients), pneumonia vaccine updated, diabetic foot exam, diabetic microalbumuria check, retinal exam, smoking cessation counseling, dental visit, and self management goal	one year

Collaborators and Investigators

• Sponsor: University of Rochester
• Collaborators: Robert Wood Johnson Foundation
• Investigators: Study Director: Kevin Fiscella, MD, MPH, University of Rochester

Publications and helpful links

Helpful Links

• Robert Wood Johnson Foundation Website on Grantees

Study record dates

Study Major Dates

• Study Start: December 1, 2006
• Primary Completion (Actual): June 1, 2010
• Study Completion (Actual): June 1, 2010

Study Registration Dates

• First Submitted: July 25, 2007
• First Submitted That Met QC Criteria: July 26, 2007
• First Posted (Estimate): July 27, 2007

Study Record Updates

• Last Update Posted (Estimate): October 14, 2013
• Last Update Submitted That Met QC Criteria: October 10, 2013
• Last Verified: October 1, 2013

More Information

Terms related to this study

• Keywords: Cardiovascular disease; Diabetes; Quality improvement; Peer review
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: 59768