Comparison of Methods to Improve Abdominal Aortic Aneurysm (AAA) Screening Rates in the Primary Care Setting.

Standard of care dictates that eligible patients should receive an abdominal aortic aneurysm (AAA) screening ultrasound. At present, different military primary care physicians utilize different methods at their discretion to ensure their patients get screened-telephone contact; mail-out reminders; referring patients for ultrasound directly from an office visit; as well as other methods-which we will refer to as "usual care". The purpose of this study is to improve screening rates for AAA and determine what notification methods are best at improving screening rates.

Study Overview

• Status: Completed
• Conditions: Abdominal Aortic Aneurysm

Detailed Description

Approximately 1700 male patients (DoD beneficiaries) between the ages of 65-75 will be selected from their medical records. The information on the attached abstracted data sheet will be collected. As part of standard patient care operations, the Family Medicine and Internal Medicine Departments will inform patients on the need to receive a AAA screening ultrasound, based on their primary care manager's (PCM) preference for clinical notification:

1. Nurse initiated Telephone Consult (T-Con) (see attached)
2. Mail-0ut Letter to the patient (see attached)
3. Provider, Nurse and Technician Education with point-of-care patient referrals , Exam Room Flyer
4. Control group (i.e. usual care)

The Provider, Nurse and Technician Education will consist of a presentation given by the Principal Investigator (see attached PowerPoint) to the Family Medicine and Internal Medicine clinic staff and the posting of Exam Room Flyers in each Family Medicine and Internal Medicine exam room to prompt and encourage patient referrals for a AAA screening ultrasound.

Information requested on the attached abstracted data sheet will be used for initial identification of patients that should have a AAA screening ultrasound and again 3-4 months later to see if these same individuals received the procedure. All informational data sets will be totally de-identified by the Research Coordinator, Nellis Air Force Base, prior to releasing to the Principle Investigator.

The data will then be analyzed by Dr. Anneke Bush (WHMC statistician) and the results will be provided to the Principal Investigator for analysis.

• Study Type: Observational
• Enrollment (Actual): 1700

Contacts and Locations

Study Locations

• United States
  • Nevada
    • Nellis AFB, Nevada, United States, 89191
      • Michael O'Callaghan Federal Hospital/Nellis Air Force Base

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years to 75 years (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

• Sampling Method: Non-Probability Sample

Study Population

We will recruit approximately 1700 males (DoD beneficiaries) between the ages of 65-75 from their existing medical diagnostic records. There will be no special populations included. Some respondents may be patients of the PI however; the data sets received by the PI will be anonymous and will not be linked directly to the subjects.

Description

Inclusion:

• Tricare Insurance Beneficiary (military insurance) receiving care at Nellis AFB
• Male patients (DoD beneficiaries) between the ages of 65-75 years old.

Exclusion:

• Female patients.
• Non-English speaking.
• Patients who have already had abdominal CT scan, abdominal MRI, aortography or aortic ultrasound.
• Patients already diagnosed with AAA

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
T-Con; 1. Nurse initiated Telephone Consult (T-Con)
Mail-Out; 2. Mail-0ut Letter to the patient
Education; 3. Provider, Nurse and Technician Education with point-of-care patient referrals , Exam Room Flyer
Control group; 4. Control group (i.e. usual care)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
improving screening rates for AAA	Will the concerted use of (1) a nurse-initiated telephone consult (T-Con), (2) mail out reminder or (3) provider, nurse and technician education with point-of-care reminders be more successful than usual care at improving screening rates for AAA?	1 year

Collaborators and Investigators

• Sponsor: Mike O'Callaghan Military Hospital
• Investigators: Principal Investigator: Ethan Zimmerman, M.D., Michael O'Callaghan Federal Hospital/Nellis Air Force Base

Study record dates

Study Major Dates

• Study Start: December 1, 2010
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): June 1, 2012

Study Registration Dates

• First Submitted: February 18, 2011
• First Submitted That Met QC Criteria: February 18, 2011
• First Posted (Estimate): February 23, 2011

Study Record Updates

• Last Update Posted (Estimate): November 25, 2013
• Last Update Submitted That Met QC Criteria: November 21, 2013
• Last Verified: November 1, 2013

More Information

Terms related to this study

• Keywords: abdominal aortic aneurysm
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Aortic Diseases; Aneurysm; Aortic Aneurysm; Aortic Aneurysm, Abdominal
• Other Study ID Numbers: FWH20110041H