- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02451059
Reducing Socioeconomic Disparities in Health at Pediatric Visits (WECARE01)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This project builds upon the PI's prior studies including a recently completed cluster randomized controlled trial (RCT) at community health centers in Boston, which demonstrated a positive impact on provider referrals, discussion, and family receipt of resources.
This study will specifically test the effectiveness of a further strengthened intervention "WE CARE 2.0" on provider referrals and family receipt of resources, along with its impact on child health, health care utilization, and developmental outcomes. Finally, we will gather information from stakeholders at the health centers in order to learn more about the facilitators and barriers to implementation of the model.
The study will take place at six community health centers in the Greater Boston area. The centers will be randomized to either an intervention or control site. Data will be collected on referrals, receipt of resources, and child outcomes from the child's electronic medical record (EMR) from birth to age 3. Focus groups will be used to gather implementation data from intervention health center personnel.
The WE CARE 2.0 intervention consists of: 1) WE CARE surveys which parents complete prior to their child's well-child visits; 2) information technology (IT) generated provider referrals which providers use to provide families with resource information sheets; 3) peer patient navigators who assist families in connecting to available resources and updating providers; and 4) training sessions for providers and office staff.
Families attending the control health centers will receive standard of care. Of note, since the health centers share a common EMR and for ethical reasons, control sites will have access to the IT generated referral mechanism.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02118
- South End Community Health Center
-
Boston, Massachusetts, United States, 02122
- Dorchester House Multi-Service Center
-
Boston, Massachusetts, United States, 02124
- Codman Square Health Center
-
Dorchester, Massachusetts, United States, 02125
- Uphams Corner Health Center
-
Mattapan, Massachusetts, United States, 02126
- Mattapan Community Health Center
-
Roslindale, Massachusetts, United States, 02131
- Greater Roslindale Medical and Dental Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Child is on Medicaid insurance
- Is attending routine newborn visit
Exclusion Criteria:
- Premature (less than or equal to 32 weeks GA)
- Has a chronic disease
- Has Neonatal Abstinence Syndrome
- Has a foster parent
Study Plan
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 |
---|---|
Experimental: Intervention-WE CARE
|
The WE CARE survey, consists of 14 questions used to identify seven unmet material needs (education, employment, food security, housing, childcare, household heat, language).
The survey will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age.
The office staff will instruct parents to give the WE CARE survey, along with the developmental screening tool, to their child's provider at the visit.
Providers will be trained to review the WE CARE survey at health supervision visits and generate referrals thru the EMR.
Specifically, they will receive a one-hour teaching session one week prior to the study implementation.
The goals for the session will include providing an overview of pediatric practice guidelines, introducing the WE CARE survey, reviewing the referral process, and discussing the role of peer patient navigators.
Study staff will conduct periodic booster sessions; study staff will also train new providers should there be staff turnover
Other Names:
The peer patient navigator will offer guidance to families with accessing community resources.
They will be available at least .5 days per week at intervention health centers to meet with families and offer guidance as well as be available via a hotline number.
The navigator will speak with families and offer guidance on community resources and offer assistance with completing applications.
In addition, they will offer to schedule and, if desired, accompany parents to the agencies.
Interpreter services will be utilized at the health centers in case the navigator does not speak the parent's language.
The navigator will also place an update note in the EMR within 1-month post-visit and one week after any contact with families.
|
No Intervention: Control-Standard of Care
Participants in the delayed-intervention control group will receive standard pediatric care.
However, since the health centers share a common EMR, and for ethical reasons, investigators will also embed the health IT referral mechanism into the EMR at the control sites.
Control providers will be made aware of this prior to the start of the study.
Although this may potentially reduce the effect size, the investigator's prior study found that the impact on referral rates of provider access to resource information was minimal.
Families at control health centers will not receive the WE CARE surveys at health supervision visits and will not have access to the peer patient navigators
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Health care utilization
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will measure whether child is up to date with well child visits between 0-3 years of age.
Investigators will measure whether child is up to date on their immunizations between 0-3 years of age.
Investigators will measure if and how many times child has been hospitalized or had a visit to the emergency department (ED) between 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Child maltreatment
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will measure in the child's EMR whether or not there are any reports of child maltreatment and/or involvement with the Department of Child and Families, at any point, from age 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Developmental delay
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will measure whether a developmental delay has been added to the child's problem list in their EMR or if provider has noted a concern of a developmental delay in their routine well-child care notes, at any point, from age 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Obesity
Time Frame: Measured at 2-year, 30-month, and 3-year well child care visits (as recommended by the American Academy of Pediatrics)
|
Investigators will record the child's reported BMI at their 2-year, 30-month, and 3-year well child care visits from the EMR
|
Measured at 2-year, 30-month, and 3-year well child care visits (as recommended by the American Academy of Pediatrics)
|
Asthma
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will record whether asthma or concerns about asthma have been added to child's problem list in the EMR or noted in the EMR by child's provider at any point, from age 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Blood pressure
Time Frame: Measured at 3-year well child care visits
|
We will record the child's reported blood pressure number as measured at their 3-year well child care visit.
We will gather this information from the EMR.
|
Measured at 3-year well child care visits
|
Provider referrals
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will measure if and how many times a provider made a referral/printed out a community resource handout for patients during their enrollment in the study at any point, from age 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Family receipt of community based resource
Time Frame: Throughout child's enrollment in study (0 years through 3 years of age)
|
Investigators will determine whether families who were printed out community resource handouts had been able to receive services from a community based resource organization.
This will be recorded in the EMR by the patient navigator at anytime from age 0-3 years of age.
|
Throughout child's enrollment in study (0 years through 3 years of age)
|
Focus group data gathered by audio recordings then transcribed and coded
Time Frame: During 1st month pilot phase and again after investigators have enrolled our the cohort, approximately 3 years after the first focus groups and the study initiation
|
Investigators will gain insight into the context and implementation of the augmented WE CARE model from providers and administrative staff at the intervention sites
|
During 1st month pilot phase and again after investigators have enrolled our the cohort, approximately 3 years after the first focus groups and the study initiation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Arvin Garg, MD MPH, Boston University Medical Campus
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- H-33061
- 1R01MD007793-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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 Obesity
-
Central Hospital, Nancy, FranceNot yet recruiting
-
University of MinnesotaNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Active, not recruitingAdolescent ObesityUnited States
-
Helsinki University Central HospitalKarolinska Institutet; Folkhälsan Researech CenterEnrolling by invitation
-
Istanbul Medipol University HospitalMedipol UniversityCompletedObesity, Morbid | Obesity, Adolescent | Obesity, Abdominal | Weight, Body | Obesity, VisceralTurkey
-
Queen Fabiola Children's University HospitalNot yet recruitingMorbid Obesity | Adolescent Obesity | Bariatric SurgeryBelgium
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; Pennington Biomedical Research... and other collaboratorsActive, not recruitingOvernutrition | Nutrition Disorders | Overweight | Body Weight | Pediatric Obesity | Body Weight Changes | Childhood Obesity | Weight Gain | Adolescent Obesity | Obesity, Childhood | Overweight and Obesity | Overweight or Obesity | Overweight AdolescentsUnited States
-
The Hospital for Sick ChildrenCompleted
-
Ihuoma EneliCompletedObesity, ChildhoodUnited States
-
Fundació Sant Joan de DéuRecruitingObesity, Childhood | Obesity, AdolescentSpain
-
Consorcio Centro de Investigación Biomédica en...Maimónides Biomedical Research Institute of Córdoba; Instituto de Salud Carlos... and other collaboratorsActive, not recruiting
Clinical Trials on WE CARE survey
-
Boston Medical CenterNational Heart, Lung, and Blood Institute (NHLBI)Completed
-
University of Massachusetts, WorcesterBoston University; Eunice Kennedy Shriver National Institute of Child Health... and other collaboratorsCompletedPatient Satisfaction | Basic Unmet Material Needs | Receipt of Community Resources | Provider ReferralsUnited States
-
University of Massachusetts, WorcesterNational Cancer Institute (NCI)Completed
-
University of MichiganNational Heart, Lung, and Blood Institute (NHLBI)RecruitingHeart Failure NYHA Class II | Heart Failure NYHA Class III | Heart Failure NYHA Class IVUnited States
-
University of South FloridaActive, not recruitingAutism Spectrum DisorderUnited States
-
University Hospital, BordeauxCompleted
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI); Lance Armstrong FoundationActive, not recruitingOvarian Cancer | Fallopian Tube Cancer | Peritoneal CancerUnited States
-
Radboud University Medical CenterNot yet recruitingAging | Aging Well | Immuno Aging
-
Florida State UniversityWayne State University; Oregon Health and Science University; Hunter College...CompletedHIV Infections | HIV/AIDSUnited States
-
Northeastern UniversityCompleted