Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial (ReSPECT)

September 2, 2015 updated by: US Department of Veterans Affairs

Interprofessional Training for Improving Diabetes Care

The investigators' study focuses on improving the care of diabetes, a complex chronic illness, by providing important insights into interprofessional training and its potential role in fostering the necessary interdisciplinary management needed for chronic conditions and in addressing the gap between best practice and actual care provided.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The complexity of diabetes management challenges the acute care-oriented healthcare system. Some experts suggest part of the problem is that the healthcare system fosters a separate silos decision making model. While there is increasing recognition that quality diabetes care is best provided in an interdisciplinary manner, interprofessional training models are limited, as is understanding of the links between interprofessional training, actual practice, and patient outcomes. Advancing our understanding of interprofessional training models is critical because most of the complications associated with diabetes (e.g., amputations, renal failure, strokes) can be prevented or delayed with proper management. The investigators' objective is to better understand the processes and mechanisms by which interprofessional training impacts on chronic care management (practice patterns) and the ways it translates into improved patient outcomes.

Study Type

Interventional

Enrollment (Actual)

117

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

  • United States
    • Ohio
      • Cleveland, Ohio, United States, 44106-3800
        • Louis Stokes VA Medical 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

25 years to 85 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

CLINICIANS

  • All clinicians in all of Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study (all PCPs have patients with DM in their panel of patients).

PATIENTS

  • All diabetic patients who are seen in Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study.

Exclusion Criteria:

CLINICIANS

  • Any clinician who does not have diabetic patients on their panel, who aren't apart of Ohio's CBOC's, or see patients at the Georgetown CBOC will not be eligible to participate.

PATIENTS

  • Patients who don't have a diagnosis of diabetes, who aren't seen at one of Ohio's CBOC's, or is seen for their medical care at the Georgetown CBOC will not be eligible to participate.

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: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control
Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.
Experimental: ReSPECT Intervention
Intervention sites will receive baseline measures pre and post, but also in-depth Shared Medical Appointments (SMA)(The Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT) intervention) and at 15 months SMA video conferences. At the end of the 18 months the randomly selected patients and providers will be asked to take part in a qualitative interview.
Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)
The intervention is designed to educate the clinicians at intervention CBOCs by modeling interprofessional team practices during SMAs for diabetes mellitus (DM) patients from each CBOC primary care provider's (PCP) patient panel. We hypothesize that this education at intervention CBOCs will improve interprofessional practices and overall quality care delivered to veterans.
Other Names:
  • ReSPECT

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network
Time Frame: Baseline

Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities:

  1. Instruct patients on home glucose monitoring
  2. Teach foot care
  3. Teach insulin administration
  4. Instruct patients about diet
  5. Help patients make changes in their diets that you have recommended
  6. Instruct patients about regular exercise
  7. Help patients make changes in their exercise habits that you have recommended
  8. Identify candidates for long-acting insulin
  9. Interpret glucose patterns
  10. Adjust insulin in insulin-treated patients with poor glycemic control
  11. Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin
  12. Manage patients with poor glycemic control
  13. Initiate insulin therapy (NPH or insulin glargine and aspart)
  14. Apply principles of diabetes care in a team setting

Averages of provider efficacy were calculated across all activities.
Baseline
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network
Time Frame: 22 months (post-intervention)

Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities:

  1. Instruct patients on home glucose monitoring
  2. Teach foot care
  3. Teach insulin administration
  4. Instruct patients about diet
  5. Help patients make changes in their diets that you have recommended
  6. Instruct patients about regular exercise
  7. Help patients make changes in their exercise habits that you have recommended
  8. Identify candidates for long-acting insulin
  9. Interpret glucose patterns
  10. Adjust insulin in insulin-treated patients with poor glycemic control
  11. Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin
  12. Manage patients with poor glycemic control
  13. Initiate insulin therapy (NPH or insulin glargine and aspart)
  14. Apply principles of diabetes care in a team setting

Averages of provider efficacy were calculated across all activities.
22 months (post-intervention)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Attitudes Toward Healthcare Teams Scale and Subscales
Time Frame: Baseline
A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.
Baseline
Attitudes Toward Healthcare Teams Scale and Subscales
Time Frame: 22 months (post-intervention)
A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.
22 months (post-intervention)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

US Department of Veterans Affairs

Collaborators

The Cleveland Clinic
Case Western Reserve University

Investigators

  • Principal Investigator: Susan R Kirsh, MD, HSR&D Central Office

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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, 2010

Primary Completion (Actual)

May 1, 2013

Study Completion (Actual)

September 1, 2013

Study Registration Dates

First Submitted

February 27, 2009

First Submitted That Met QC Criteria

March 2, 2009

First Posted (Estimate)

March 3, 2009

Study Record Updates

Last Update Posted (Estimate)

October 6, 2015

Last Update Submitted That Met QC Criteria

September 2, 2015

Last Verified

September 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • EDU 08-414

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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