- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04452331
Assessing Open Access Audio (OAA)
September 19, 2023 updated by: VA Office of Research and Development
An Assessment of Open Access Audio of the Clinical Encounter on Veterans and Their Care
The medical encounter can be overwhelming in term of the amount of information discussed, its technical nature, and the anxiety it can generate.
Easy access to a secure audio recording from any internet enabled device is an available low cost technology that allows patients to "revisit the visit" either alone or sharing with caretakers and family.
It has been introduced and tested outside the VA with evidence that it increases patient recall and understanding and may even improve physician performance.
Little is known, however, about whether and to what extent these effects lead to better outcomes, such as improved treatment plan adherence and chronic disease self-management.
This study is a randomized controlled trial designed ascertain whether easy access to audio recordings of the medical visit improves patients perception that they understand and can manage their own care, and leads to a variety of improved outcomes, such as better blood pressure and diabetes control, and fewer emergency department visits and hospitalizations.
Study Overview
Status
Recruiting
Conditions
Detailed Description
The study aims to assess (1) the impact of an open access audio (OAA) program on two behaviors (patient activation, treatment plan adherence), and two chronic condition measures (glycosylated hemoglobin, blood pressure); (2) the impact of open access audio on provider communication and on their attention to patient contextual factors (i.e.
individual Veteran's needs and circumstances relevant to planning effective care); and (3) patient, provider, and leadership perceptions of the extent to which the program is safe, not burdensome, and worthwhile at both the start and at two years into the program.
A secondary analysis will descriptively measure the effect size of OAA on ED visits and hospital admissions.
Study Type
Interventional
Enrollment (Estimated)
2308
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 Contact
- Name: Saul J Weiner, MD
- Phone Number: (312) 413-2799
- Email: saul.weiner@va.gov
Study Contact Backup
- Name: Gunjan S Sharma, PhD
- Phone Number: (312) 569-6486
- Email: Gunjan.Sharma2@va.gov
Study Locations
-
-
Illinois
-
Chicago, Illinois, United States, 60612
- Recruiting
- Jesse Brown VA Medical Center, Chicago, IL
-
Contact:
- Karen M Lenehan
- Phone Number: 312-569-6343
- Email: Karen.Lenehan@va.gov
-
Principal Investigator:
- Saul J. Weiner, MD
-
-
Ohio
-
Cleveland, Ohio, United States, 44106-1702
- Not yet recruiting
- Louis Stokes VA Medical Center, Cleveland, OH
-
Contact:
- Corinna D Falck-Ytter, MD
- Email: Corinna.Falck-Ytter@va.gov
-
Contact:
- Sherry L Ball, PhD
- Phone Number: 5830 (216) 791-2300
- Email: sherry.ball@va.gov
-
Sub-Investigator:
- Corinna D. Falck-Ytter, MD
-
-
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 and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Description
Inclusion Criteria:
- All patients with scheduled appointments at the participating sites: primary care and diabetes clinics at Jesse Brown VA Medical Center and the Louis Stokes Cleveland VA Medical Center
Exclusion Criteria:
- None
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: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: OAA Intervention
Visit recorded, both patient and provider aware, both patient and provider have access to audio post-visit
|
Patient obtains secure access to an audio recording of the medical encounter post-visit that is accessible from any internet enabled device.
Other Names:
|
Sham Comparator: OAA Physician Aware Control
Visit recorded, both patient and provider aware, neither patient nor provider have access to audio post-visit
|
Patient does not obtain access to audio recording but both patient and provider are aware visit is being recorded.
Other Names:
|
Placebo Comparator: OAA Physician Unaware Control
Visit recorded, patient aware but provider unaware, neither patient nor provider have access to audio post-visit
|
Patient does not obtain access to audio recording and provider is unaware visit is being recorded.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Blood pressure
Time Frame: 6 months
|
This outcome tests the hypothesis that blood pressure control improves in patients with blood pressure > 140/90 when they have access to an audio recording of their visit with their provider regarding blood pressure management compared to those who do not.
An improvement in blood pressure is defined as a reduction of 10 or more mmHg in either the systolic or diastolic blood pressure.
|
6 months
|
Glycosylated Hemoglobin (HgB A1c)
Time Frame: 4-6 months
|
This outcome tests the hypothesis that HgB A1c improves in patients with Hgb A1c > 7 when they have access to an audio recording of their discussion with their provider regarding diabetes management compared to when they do no.
An improvement is defined as a decrease of 1% or more.
|
4-6 months
|
Return Visit Adherence (RVA)
Time Frame: 6 months
|
This outcome tests the hypothesis that return visit adherence (RVA) improves in patients with non-adherence when they have access to an audio recording of their discussion with their provider.
RVA is the percentage of all scheduled visits to any clinics at the facility that the patient attends.
Non-adherence is defined as an RVA < 80% during the 6 months prior to the audio recorded visit.
A reduction in the RVA of 10% or more is an improved outcome.
|
6 months
|
Prescription Refill Rate (PDC -- Proportion of Days Covered)
Time Frame: 6 months
|
This outcome tests the hypothesis that PDC improves in patients with non-adherence when they have access to an audio recording of their discussion with their provider compared to when they do not.
PDC is the total number of days covered by refills in a measurement period divided by the number of days between the first fill and the end of the measurement period.
Non-adherence is defined as a PDC<80% during the 6 months prior to the audio recorded visit.
An improved outcome is defined as a 10% or greater improvement post visit in any patient classified as non-adherent pre-visit.
|
6 months
|
Patient Activation Measure (PAM)
Time Frame: 2 weeks
|
This outcome tests the hypothesis that patient activation is higher in patients when they have access to an audio recording of their visit with their provider compared to when they do not.
Patients are called by phone post visit to answer PAM 10, a 10 item questionnaire with a 5 point Likert response that scores their perceived knowledge, skills, and confident in their capacity to follow their treatment plan with scores from 0-100.
A higher score indicates higher patient activation.
|
2 weeks
|
SEGUE Framework for evaluating and scoring communication behavior.
Time Frame: 2 weeks
|
This outcome tests the hypothesis that physicians communicate more effectively when they are aware the visit is being recorded for the patient to when they are not.
Communication behavior will be rated off the audio recording by a research assistant utilizing the SEGUE checklist.
Outcome measure is total score on 32 item SEGUE instrument with a higher score indicating more effective communication.
|
2 weeks
|
Contextualization of Care
Time Frame: 2 weeks
|
This outcome tests the hypothesis that physicians are more likely to contextualize the care plan when they are aware the visit is being recorded for the patient to when they are not.
Contextualization of care will be rated off of the audio recording by a research assistant trained in Content Coding for Contextualization of Care (4C Coding).
Outcome measure is the percentage of encounters in which the care plan was coded as contextualized.
|
2 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Emergency department utilization
Time Frame: 6 months
|
This outcome tests the hypothesis that emergency department visit rates are lower following encounters in which patients have access to an audio recording of their visit with their provider compared to when they do not.
Outcome measure is the average number of ED visits during the designated (6 month) time period following the audio recorded visit.
|
6 months
|
hospital admission rate
Time Frame: 6 months
|
This outcome tests the hypothesis that inpatient admission rates are lower following encounters in which patients have access to an audio recording of their visit with their provider compared to when they do not.
Outcome measure is the average number of inpatient admissions during the designated (6 month) time period following the audio recorded visit.
|
6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Saul J. Weiner, MD, Jesse Brown VA Medical Center, Chicago, IL
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)
October 5, 2021
Primary Completion (Estimated)
July 31, 2024
Study Completion (Estimated)
July 31, 2024
Study Registration Dates
First Submitted
June 25, 2020
First Submitted That Met QC Criteria
June 25, 2020
First Posted (Actual)
June 30, 2020
Study Record Updates
Last Update Posted (Actual)
September 21, 2023
Last Update Submitted That Met QC Criteria
September 19, 2023
Last Verified
September 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IIR 19-068
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
product manufactured in and exported from the U.S.
No
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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