- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02560090
Bamberg Diabetes Transitional Care Pilot Study
March 21, 2018 updated by: Carolyn Jenkins, Medical University of South Carolina
Transforming Patient-Centered Medical Homes Into Medical Communities for Underserved Rural Patients
Bamberg County residents who has been diagnosed with or is at high risk for diabetes, may be eligible for a clinical research study to improve diabetes self-management and decrease hospital re-admissions.
The purpose of this study is to compare the effectiveness of three hospital discharge follow-up methods:
- standard of care,
- a nurse telephone intervention (care coordination and education), and
- an in-home community health worker intervention (care coordination and education).
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
58
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
-
-
South Carolina
-
Orangeburg, South Carolina, United States, 29118
- The Regional Medical Center of Orangeburg and Calhoun Counties
-
-
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 to 75 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Bamberg County resident
- between 18 and 75 years of age
- a patient discharged from the Regional Medical Center emergency department or Regional Medical Center hospital within 72 hours prior to consent
- diagnosed with diabetes or at high risk for diabetes
- will be a Regional Medical Center patient for follow-up care
- speaks English
- has access to a phone
Stage 2 Recruitment:
- If recruitment at 3 weeks after the first patient is enrolled is < 15 or the recruitment at 12 weeks is < 45, additional inclusion criteria will include the following: Regional Medical Center outpatient or unassigned community member with uncontrolled diabetes (defined as A1C >8 or blood pressure >140/90) is uninsured or who self-reports problems with obtaining medications.
Exclusion Criteria:
- end-stage renal disease
- terminal illness (e.g., advanced cancer, end-stage chronic obstructive pulmonary disease, advanced dementia)
- incarceration
- resident in a skilled nursing home.
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: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Control Group
Survey assessments as well as collection of medical records and billing information.
|
The following information will be collected: demographics, literacy screener, depression screener, medication adherence, self-efficacy, tobacco use, patient activation, health questionnaire, eating patterns, diabetes self-management assessment, stages of change questionnaire, vitals, and self-care behaviors.
|
Active Comparator: Telephonic Nurse Intervention
Survey assessments as well as collection of medical records and billing information.
A nurse will communicate with participants via telephone to support diabetes self-management practices.
|
The following information will be collected: demographics, literacy screener, depression screener, medication adherence, self-efficacy, tobacco use, patient activation, health questionnaire, eating patterns, diabetes self-management assessment, stages of change questionnaire, vitals, and self-care behaviors.
A nurse will contact patients by phone at least weekly for month 1 and at least every other week for months 2 and 3 and will collect the following information: medication adherence, discharge plan adherence, problem solving, diet and physical activity issues and to assess self-management, dietary, and physical activity improvements.
In addition the nurse will link participants with resources.
|
Active Comparator: In-person Community Health Worker Intervention
Survey assessments as well as collection of medical records and billing information.
A community health worker will work with participants in person to support diabetes self-management practices.
|
The following information will be collected: demographics, literacy screener, depression screener, medication adherence, self-efficacy, tobacco use, patient activation, health questionnaire, eating patterns, diabetes self-management assessment, stages of change questionnaire, vitals, and self-care behaviors.
An in-person Community Health Worker will contact patients in-person at least weekly for month 1 and at least every other week for months 2 and 3 and will collect the following information: medication adherence, discharge plan adherence, problem solving, diet and physical activity issues and to assess self-management, dietary, and physical activity improvements.
In addition the nurse will link participants with resources.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of Number of Hospital Re-admissions from 2 Years Prior to Study Enrollment to 1 Year After Study Completion
Time Frame: Retrospective billing collection 2 years prior to study enrollment and 1 year after study completion
|
Hospital data will be obtained from Revenue and Financial Affairs South Carolina Data Oversight Council.
These data come from the health organization where patients receive care and include components such as age, health care facility type, dates of admission/ discharge, length of stay, charges, payment source, primary and secondary procedure codes.
|
Retrospective billing collection 2 years prior to study enrollment and 1 year after study completion
|
Change of Self-management Success Measured by Diabetes Self-Management Assessment Survey Tool from Baseline to Study Completion
Time Frame: Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
Diabetes self-management assessment tool administered to participant over the phone or in-person
|
Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change of Health Goal Progress Captured by Field Notes to Track Intervention Activities from Baseline to Study Completion
Time Frame: Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
Field Notes are completed after each interventionist's interaction with the participant to track progress to addressing health goals
|
Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
Change of Diet Measured By a 24-item Introduction to the Lifestyle Survey from Baseline to Study Completion
Time Frame: Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
The 24-item Introduction to the Lifestyle Survey will be used to assess diet (fats, protein, fruits and vegetables) and at enrollment, week 4 and 12
|
Baseline, 1 month post-enrollment, 2 months post-enrollment, 3 months post-enrollment (study completion)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Carolyn Jenkins, DrPh, MSN, Medical University of South Carolina
- Principal Investigator: Samuel Cykert, MD, University of North Carolina, Chapel Hill
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 (Actual)
June 1, 2015
Primary Completion (Actual)
October 1, 2017
Study Completion (Actual)
October 1, 2017
Study Registration Dates
First Submitted
July 15, 2015
First Submitted That Met QC Criteria
September 23, 2015
First Posted (Estimate)
September 25, 2015
Study Record Updates
Last Update Posted (Actual)
March 22, 2018
Last Update Submitted That Met QC Criteria
March 21, 2018
Last Verified
March 1, 2018
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00038334
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 Diabetes
-
University of Colorado, DenverMassachusetts General Hospital; Beta Bionics, Inc.CompletedDiabetes Mellitus, Type 1 | Type 1 Diabetes | Diabetes type1 | Type 1 Diabetes Mellitus | Autoimmune Diabetes | Diabetes Mellitus, Insulin-Dependent | Juvenile-Onset Diabetes | Diabetes, Autoimmune | Insulin-Dependent Diabetes Mellitus 1 | Diabetes Mellitus, Insulin-Dependent, 1 | Diabetes Mellitus, Brittle | Diabetes Mellitus, Juvenile-Onset and other conditionsUnited States
-
Guang NingRecruitingType 2 Diabetes Mellitus | Type1 Diabetes Mellitus | Monogenetic Diabetes | Pancreatogenic Diabetes | Drug-Induced Diabetes Mellitus | Other Forms of Diabetes MellitusChina
-
University of Trás-os-Montes and Alto DouroCompletedType 2 Diabetes Mellitus | Diabetes-Related ComplicationsPortugal
-
Northern Care Alliance NHS Foundation TrustBrighter ABCompletedDiabetes type1 | Diabetes type2United Kingdom
-
VeraLight, Inc.InLight SolutionsUnknownGestational Diabetes | Insulin Dependent Diabetes | Non Insulin Dependent DiabetesUnited States
-
Garvan Institute of Medical ResearchWeizmann Institute of ScienceActive, not recruitingType 2 Diabetes Mellitus | Pre DiabetesAustralia
-
Oregon State UniversitySanofiCompletedType I or Type II Diabetes (Excludes Gestational Diabetes)
-
Taichung Veterans General HospitalNational Health Research Institutes, TaiwanRecruitingDiabetes Complications | Type 2 Diabetes | Maturity-Onset Diabetes of the Young (MODY)Taiwan
-
University of RoehamptonRecruitingType2 Diabetes Mellitus | Pre DiabetesUnited Kingdom
-
Peking Union Medical College HospitalUnknownType 2 Diabetes Mellitus | Type 1 Diabetes Mellitus | Gestational Diabetes Mellitus | Pancreatogenic Diabetes Mellitus | Pregestational Diabetes Mellitus | Diabetes Patients in Perioperative PeriodChina
Clinical Trials on Surveys
-
Memorial Sloan Kettering Cancer CenterCompletedRectal Cancer | Colon CancerUnited States
-
University of MichiganNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Not yet recruiting
-
RANDClaremont Graduate UniversityCompleted
-
Elysium HealthUniversity of OxfordNot yet recruitingBiological Aging
-
H. Lee Moffitt Cancer Center and Research InstituteCompletedMuscle-Invasive Bladder Carcinoma | Bladder Cancer Stage II | Bladder Cancer Stage III | Bladder Cancer Stage IVUnited States
-
University Hospital, AngersCompletedOpioid-Related Disorders | Critically Ill | Pain, ChronicFrance
-
Mayo ClinicCompletedCesarean SectionUnited States
-
Hospital for Special Surgery, New YorkCompletedPain, Postoperative | TSA | BruiseUnited States
-
Northwestern UniversityCompleted