Controlling Hypertension Through Education and Coaching in Kidney Disease (CHECK-D)

Chronic kidney disease (CKD) is a serious and growing public health problem. The purpose of this study is to find out if an educational worksheet, called the Encounter Decision Intervention (EDI), combined with health coaching helps CKD patients improve their blood pressure and other health outcomes. The research team hypothesizes that the intervention group will have greater improvement in CKD outcomes than the control group.

Study Overview

• Status: Active, not recruiting
• Conditions: Chronic Kidney Diseases; Chronic Disease; Chronic Kidney Disease Stage 5; Chronic Kidney Disease, Stage 4 (Severe); Chronic Kidney Disease, Stage 3 (Moderate)
• Intervention / Treatment: Behavioral: Control-EDI; Behavioral: Intervention-EDI and health coaching

Detailed Description

Patients that meet eligibility criteria and are seen in a clinic assigned to the control group will be given a Control-Encounter Decision Intervention (Control-EDI) about kidney disease in general (not tailored to the patient) by their primary care provider. Eligible patients that agree to participate and give consent will complete enrollment, 1, 6, and 12 month follow-up visits.

Eligible patients that are seen in a clinic assigned to the intervention group will be given a personalized Intervention-EDI by their primary care provider. Following this, eligible patients that agree to participate and give consent will complete the enrollment visit, and have a baseline call with a health coach. In addition to the 1, 6, 12 month follow-up visits these patients will also have approximately 4-6 phone calls with the health coach between the baseline visit and 11 months after enrollment.

In both groups the study team will be collecting medical information and assessments regarding their health; blood sample and urine samples at baseline and 12 months; approximately 4-6 phone calls; as well as surveys at various time points.

In order to reduce in-person human subject activity due to the Coronavirus disease 2019 (COVID-19) pandemic, participants in both groups receive an at home blood pressure monitor so that systolic- & diastolic-BP data can be collected at all 4 time points (baseline, 1, 6, 12 months).

• Study Type: Interventional
• Enrollment (Actual): 320
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ying-Jen Lin; Email: yingjen@umich.edu
• Study Contact Backup: Name: Julie Wright; Phone Number: 734-764-5178; Email: juwright@med.umich.edu

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48105
      • University of Michigan / Domino's Farms
    • Ann Arbor, Michigan, United States, 48108
      • University of Michigan / Briarwood Family Medicine
    • Brighton, Michigan, United States, 48116
      • University of Michigan / Brighton Health Center
    • Canton, Michigan, United States, 48187
      • University of Michigan / Canton Health Center
    • Chelsea, Michigan, United States, 48118
      • University of Michigan / Chelsea Health Center
    • Detroit, Michigan, United States, 48201
      • University Health Center - GMAP/Gen Med
    • Detroit, Michigan, United States, 48201
      • University Health Center - Med Peds
    • Dexter, Michigan, United States, 48130
      • University of Michigan / Dexter Health Center
    • Livonia, Michigan, United States, 48152
      • University of Michigan / Livonia Health Center
    • Northville, Michigan, United States, 48168
      • University of Michigan / Northville Health Center
    • Ypsilanti, Michigan, United States, 48198
      • University of Michigan / Ypsilanti Health Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 85 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosis of CKD stage 3, 4, or 5 documented in medical record
• Aware of CKD diagnosis
• Has diagnosis of hypertension documented in medical record and most recent Blood Pressure (BP) within the last year meets criteria of uncontrolled hypertension (≥140 mmHg, and/or a diastolic blood pressure ≥90 mmHg noted in an ambulatory care setting within the past one year)
• Estimated glomerular filtration rate (eGFR) of <60 within the last 18 months documented in the medical record

Exclusion Criteria:

• Currently on dialysis permanently (i.e. are considered "end-stage renal disease" and receiving dialysis)
• Previous kidney transplant
• Pregnant (indicated by medical record or if patient self-identifies as pregnant)
• Has cognitive, language, or vision impairment(s) that would prohibit participating in education, taking surveys, or participating in coaching activities
• Has terminal illness

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; Eligible patients enrolled from the control group clinics will be given a Control-EDI which has information about kidney disease in general (not tailored to the patient) during their clinic visit.	Behavioral: Control-EDI; Patients in the control group will receive Control-EDI from their primary care provider during clinic visit. Subsequent patient CKD education and follow-up will be provider dependent. Patients will be called and reminded of their study visits at 1, 6, 12 months to complete study measures, BP checks, and give urine and blood samples (baseline and 12-month visit only).; Other Names: Control-Encounter Decision Intervention
Experimental: Intervention; Eligible patients enrolled from the intervention group clinics will be given an Intervention-EDI which has personalized information about kidney disease. There will be space on this for the provider to type in any goals or key points they want the patient to remember. Additionally, patients in this group will also receive health coaching.	Behavioral: Intervention-EDI and health coaching; Patients in the intervention group will receive a personalized Intervention-EDI from their primary care provider during visit, which will include their most recent BP, their urine protein level and most recent eGFR. There is also a space for their provider to type in a sentence about specific goals for the patient. Health coaches will conduct a baseline call and 4-6 coaching calls, based on patient's needs, over an 11-month period. There are 4 topic areas related to blood pressure and CKD that will be the focus of the calls. Coaches will also have pre-determined and vetted educational resources to provide patients if needed. Additionally, patients will be called and reminded of their study visits at 1, 6, 12 months to complete study measures, BP checks, and give urine and blood samples (baseline and 12-month visit only).; Other Names: Intervention-Encounter Decision Intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Systolic Blood Pressure between baseline and 12 months	Changes in systolic blood pressure between baseline and 12 months will be compared between the intervention group and control group.	Baseline, 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Diastolic Blood Pressure between baseline and 12 months	Changes in diastolic blood pressure between baseline and 12 months will be compared between the intervention group and control group.	Baseline, 12 months
Slope of systolic BP between baseline and 12 months using all available BP values	BP will be collected at 4 time points - baseline, 1, 6, 12 months. This will be compared between the intervention group and control group.	Baseline up to 12 months
Slope of diastolic BP between baseline and 12 months using all available BP values	BP will be collected at 4 time points - baseline, 1, 6, 12 months. This will be compared between the intervention group and control group.	Baseline up to 12 months
CKD knowledge measured by the Kidney Knowledge Survey (KiKS)	This is a 28-item questionnaire measuring objective CKD disease knowledge and includes questions about goals, cardiovascular risk, and anti-hypertensive medications. Patients will answer the questions with a yes or no answer and their score will be based on how many responses were correct. This number will be converted to a percentage.	Baseline up to 12 months
Medication Adherence Self-Efficacy Scale-Revised (MASES-R)	This is a 13-item measure with the answers on a Likert scale of 1 (not at all sure) to 4 (extremely sure). The higher the score the higher the self-efficacy, with a range from 13-52.	Baseline up to 12 months
Morisky Medication Adherence Scale (MMAS - 8)	This scale is to quantify adherence to pharmacological treatments by 8 items. Levels of adherence are based on the following scores: <6 = low adherence; 6-<8 = medium adherence; 8 = high adherence.	Baseline up to 12 months
Visit Time with provider	Length of time provider spends with the patient. This will be compared between the intervention group and control group.	Enrollment visit (baseline)
Total time in clinic	Length of time between patient check-in and check-out. This will be compared between the intervention group and control group.	Enrollment visit (baseline)
Patient Motivation by the Treatment Self-Regulation Questionnaire scale (TSRQ)	This contains a 17-item questionnaire in which the participants select scores from 1-7 or does not apply. A number of 1 = not at all and a score of 7 = considered very true, and zero = not applicable.	Baseline up to 12 months
Satisfaction with CKD care based on Communication Assessment Tool (CAT)	This is a 15-item questionnaire that assesses the quality of physician to patient communication completed by the patients. There are 5 answers to choose from; poor, fair, good, very good, and excellent. The Score range is 1-5, where 1 means negative perception of communication and 5 means positive perception of communication.	Baseline up to 12 months
Satisfaction with CKD care based on Consultation Care Measure (CCM)	This is a 21-item questionnaire that is completed by the patients, and select from the the 4 choices: very strongly agree, strongly agree, agree, and neutral/disagree. Each answer is worth one point on a Likert scale with a higher score meaning more satisfied.	Baseline up to 12 months
Perceptions of health coaching for the intervention group	During health coach phone calls, participants will be asked 37 questions about their perceptions of the health coach program, including how much their participation in CHECK-D helped participants change various behaviors. Participant responses will be used to examine various measures of reliability and validity during the analyses of data acquired though this survey.	Baseline up to 12 months
Medication adherence from the electronic medical record (EMR)	The EMR will be reviewed to evaluate the patients medication refills for adherence.	Baseline up to 12 months
Self-efficacy for disease self-management based on The Perceived Kidney/Dialysis Self-Management Scale (PKDSMS)	This is an 8-item scale regarding self-efficacy where each statement is rated on the level of agreement from 1-5. 1 is disagree and 5 is agree.	Baseline up to 12 months
Self-reported Blood Pressure-Related Behaviors Survey	This is a 5-item survey about knowledge and behaviors regarding sodium in the diet.	Baseline up to 12 months
Provider Adoption based on EMR query and patient survey	Provider adoption will be measured by the percentage of enrolled patients whose providers used the EDI with them during their visit. Data will be collected by EMR query and a 1-item question in the patient survey.	Baseline
Provider Fidelity measured by EMR query	Provider fidelity will be measured by the percentage of enrolled patients in the intervention clinics whose providers entered 1-2 patient specific goals in the EDI. This will be collected through EMR query.	Baseline
Provider Perception of Usefulness by provider survey	Provider perception of usefulness will be measured by a survey of 2-3 questions about how useful they thought it was.	Baseline up to 12 months
Change in serum creatinine	Change in Serum Creatinine between baseline and 12-months	Baseline, 12 months
Change in urine protein-creatinine ratio		Baseline, 12 months
Change in estimated glomerular filtration rate (eGFR)		Baseline, 12 months

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Julie Wright, MD, University of Michigan

Study record dates

Study Major Dates

• Study Start (Actual): February 4, 2020
• Primary Completion (Estimated): May 31, 2025
• Study Completion (Estimated): May 31, 2025

Study Registration Dates

• First Submitted: August 24, 2019
• First Submitted That Met QC Criteria: September 10, 2019
• First Posted (Actual): September 12, 2019

Study Record Updates

• Last Update Posted (Actual): January 10, 2024
• Last Update Submitted That Met QC Criteria: January 8, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Urologic Diseases; Disease Attributes; Renal Insufficiency; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Hypertension; Kidney Diseases; Renal Insufficiency, Chronic; Chronic Disease
• Other Study ID Numbers: HUM00136011; R01DK115844-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No