- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04790617
ENCOMPASS: Expansion Study B, RCT (ENCOMPASS)
Enhancing Community Health Through Patient Navigation, Advocacy and Social Support (ENCOMPASS): Expansion Study B, A Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Community Health Navigators (CHNs) are defined as community health workers that provide patient navigation. Based on evidence to date, CHNs for chronic disease management are likely to beneficially impact patient experience, clinical outcomes and costs; however, contextual evidence is lacking given that most studies to date have been conducted in the United States. In Canada, patient navigation programs currently exist in only a few settings (primarily cancer treatment and transitional care), with few navigation programs implemented in chronic disease care.
The ENCOMPASS program of research was initiated in 2016, when researchers with the University of Calgary's Interdisciplinary Chronic Disease Collaboration partnered with Mosaic Primary Care Network (PCN) to develop, implement and evaluate a community health navigation program for patients with multiple chronic conditions. The program was based on a systematic literature review and refined in consultation with key stakeholders. A cluster-randomized controlled trial is currently ongoing with Mosaic PCN to determine the impact of the program on acute care use, patient-reported outcomes and experience, and disease-specific clinical outcomes (NCT03077386).
Alberta Primary Care Networks (PCNs) are comprised of groups of family physicians and other health care professionals working together to provide comprehensive patient care to Albertans. To understand if the community health navigator program can be feasibly scaled and spread to PCNs across Alberta, we are expanding research to examine and evaluate community health navigation program implementation to other geographic areas and populations. This study expands the ENCOMPASS program of research to select Calgary West Central PCN primary care clinics. The current study employs the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to examine the scalability of the community health navigation program.
The objectives of this study are to (1) assess the impact of the intervention on the target population and health system (effectiveness); (2) explore the feasibility and appropriateness of practical intervention scale-up (reach, adoption, implementation, and maintenance), and (3) identify the required resources and infrastructure necessary to maintain and scale the intervention provincially.
The effectiveness of the community health navigator program will be studied using a two-armed, pragmatic, randomized controlled trial. This study will employ patient-level block randomization stratified by study site. Randomization will be concealed and computer-generated, and research staff will be blinded to block size. Primary outcomes will be assessed using administrative health data. Secondary outcomes will be measured using a patient health survey administered by a research assistant at baseline, 6 months, and 12 months. A concurrent qualitative study will provide contextual information on the effectiveness of the community health navigator program from patient, provider, and CHN perspectives. Process evaluation metrics and interviews with program stakeholders will inform the feasibility and sustainability of the community health navigator program in Alberta PCNs.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Kerry A McBrien, MD, MPH
- Phone Number: 403-210-8625
- Email: kamcbrie@ucalgary.ca
Study Contact Backup
- Name: Natalie C Ludlow, PhD
- Phone Number: 403-210-7651
- Email: natalie.ludlow@ucalgary.ca
Study Locations
-
-
Alberta
-
Calgary, Alberta, Canada
- Calgary West Central Primary Care Network
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Poorly controlled hypertension (most recent systolic blood pressure > 160 mmHg or labile);
- Poorly controlled diabetes (A1C > 9% on at least one occasion within the past year or labile);
- Stage 3b or greater chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73m2 in past year);
- Established ischemic heart disease (at least one instance of a physician billing diagnosis with a relevant International Classification of Diseases, 9th Edition [ICD-9] code recorded in electronic medical record (EMR), or known to health care team);
- Congestive heart failure (at least one instance of a physician billing diagnosis with a relevant ICD-9 code recorded in EMR, or known to health care team);
- Chronic obstructive pulmonary disease OR Asthma with at least two visits in the past year (at least 2 instances of a physician billing diagnosis with a relevant ICD-9 code, or known to health care team).
Exclusion Criteria:
- Patient unable to provide informed consent;
- Patient residing in long-term care facility;
- Health care provider discretion.
Study Plan
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 |
---|---|
Experimental: Intervention
Community health navigator program for six months.
|
Patients will be matched to a community health navigator (CHN) who will conduct a needs assessment to determine the frequency of meetings.
A CHN may perform any of the following: providing information to a patient's health care provider, translation, advocating for the patient, connecting the patient with resources (e.g., social, financial, insurance), helping patients set health-related goals, facilitating health care referrals and appointments, and monitoring appointments.
These activities may require the CHN to be physically present at appointments or have direct contact with the patient's health care provider.
Goal setting and support will be provided in-person or over the telephone using motivational interviewing principles.
Other Names:
|
No Intervention: Control
Usual health care.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acute care service use
Time Frame: Up to 36 months
|
Rate of emergency department visits and hospital admissions based on administrative health data.
|
Up to 36 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Health-related quality of life
Time Frame: Up to 12 months
|
EuroQol EQ-5D-5L.
|
Up to 12 months
|
Patient experience of care
Time Frame: Up to 12 months
|
11-item modified Patient Assessment of Chronic Illness Care (PACIC).
|
Up to 12 months
|
Patient activation
Time Frame: Up to 12 months
|
10-item Patient Activation Measure (PAM-10), score and level.
|
Up to 12 months
|
Anxiety symptoms
Time Frame: Up to 12 months
|
7-item Generalized Anxiety Disorder (GAD-7).
|
Up to 12 months
|
Depressive symptoms
Time Frame: Up to 12 months
|
9-item Patient Health Questionnaire (PHQ-9).
|
Up to 12 months
|
Perceived social support
Time Frame: Up to 12 months
|
8-item modified Medical Outcomes Study Social Support Survey (mMOS-SS).
|
Up to 12 months
|
Health literacy
Time Frame: Up to 12 months
|
3-item Brief Screening Questions for Health Literacy.
|
Up to 12 months
|
General self-rated health
Time Frame: Up to 12 months
|
1-item Self-Rated Health (SRH).
|
Up to 12 months
|
Household food security
Time Frame: Up to 12 months
|
6-item Household Food Security Survey Module (HFSSM).
|
Up to 12 months
|
Smoking status
Time Frame: Up to 12 months
|
Self-reported smoking status.
|
Up to 12 months
|
Weight
Time Frame: Up to 12 months
|
Change in self-reported weight in kilograms or pounds.
|
Up to 12 months
|
Disease-specific intermediate health outcomes: Diabetes
Time Frame: Up to 24 months
|
Change in mean glycosylated hemoglobin (A1C) based on laboratory data.
|
Up to 24 months
|
Disease-specific intermediate health outcomes: Hypertension
Time Frame: Up to 12 months
|
Change in systolic blood pressure (SBP) in mmHg based on primary data collection.
|
Up to 12 months
|
Disease-specific intermediate health outcomes: COPD/asthma
Time Frame: Up to 24 months
|
Exacerbations based on administrative health data.
|
Up to 24 months
|
Disease-specific intermediate health outcomes: Ischemic heart disease, chronic kidney disease, diabetes
Time Frame: Up to 24 months
|
Appropriate use of a statin where indicated based on pharmaceutical information network (PIN) dispensation data.
|
Up to 24 months
|
Patient experience
Time Frame: Up to 12 months
|
Based on semi-structured interviews.
|
Up to 12 months
|
Provider satisfaction
Time Frame: Up to 12 months
|
Based on semi-structured interviews.
|
Up to 12 months
|
Continuity of care
Time Frame: Up to 24 months
|
Provider attachment based on Usual Provider of Care (UPC) Index in Alberta practitioners claims file.
|
Up to 24 months
|
Physician costs
Time Frame: Up to 24 months
|
Physician claims based on physician claims files.
|
Up to 24 months
|
Acute care costs
Time Frame: Up to 24 months
|
Hospital admission and emergency department visit costs based on administrative health data.
|
Up to 24 months
|
All-cause mortality
Time Frame: Up to 24 months
|
All-cause mortality rate based on administrative data.
|
Up to 24 months
|
Medication adherence
Time Frame: Up to 24 months
|
≥80% of days covered for medications in Care Plan based on pharmaceutical information network (PIN) dispensation data.
|
Up to 24 months
|
Primary Care Network (PCN) multidisciplinary team access
Time Frame: Up to 24 months
|
umber of visits to multidisciplinary health team members based on PCN records.
|
Up to 24 months
|
Program costs
Time Frame: Up to 24 months
|
Administrative, training, and operational costs of program, assessed through PCN financial records.
|
Up to 24 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Kerry A McBrien, MD, MPH, University of Calgary
Publications and helpful links
General Publications
- Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, Shannon RP, Long JA. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med. 2014 Apr;174(4):535-43. doi: 10.1001/jamainternmed.2013.14327.
- Lehmann U, Sanders, D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs an impact on health outcomes of Using community health workers. Geneva: World Health Organization. 2007.
- Najafizada SA, Bourgeault IL, Labonte R, Packer C, Torres S. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 Mar 12;106(3):e157-64. doi: 10.17269/cjph.106.4747.
- Addressing chronic disease through community health workers: A policy and systems-level approach. Centers for Disease Control and Prevention. 2015.
- Kangovi S, Grande D, Trinh-Shevrin C. From rhetoric to reality--community health workers in post-reform U.S. health care. N Engl J Med. 2015 Jun 11;372(24):2277-9. doi: 10.1056/NEJMp1502569. No abstract available.
- Burns ME, Galbraith AA, Ross-Degnan D, Balaban RB. Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions. Int J Qual Health Care. 2014 Aug;26(4):358-65. doi: 10.1093/intqhc/mzu046. Epub 2014 Apr 16.
- Enard KR, Ganelin DM. Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. J Healthc Manag. 2013 Nov-Dec;58(6):412-27; discussion 428.
- Herman D, Conover S, Felix A, Nakagawa A, Mills D. Critical Time Intervention: an empirically supported model for preventing homelessness in high risk groups. J Prim Prev. 2007 Jul;28(3-4):295-312. doi: 10.1007/s10935-007-0099-3. Epub 2007 Jun 1.
- Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial. Am J Public Health. 2017 Oct;107(10):1660-1667. doi: 10.2105/AJPH.2017.303985. Epub 2017 Aug 17.
- Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, Gitlin LN, Han HR. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. Am J Public Health. 2016 Apr;106(4):e3-e28. doi: 10.2105/AJPH.2015.302987. Epub 2016 Feb 18.
- Carrasquillo O, Lebron C, Alonzo Y, Li H, Chang A, Kenya S. Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial. JAMA Intern Med. 2017 Jul 1;177(7):948-954. doi: 10.1001/jamainternmed.2017.0926.
- Morgan AU, Grande DT, Carter T, Long JA, Kangovi S. Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center. Am J Public Health. 2016 Nov;106(11):1958-1960. doi: 10.2105/AJPH.2016.303366. Epub 2016 Sep 15.
- McBrien KA, Ivers N, Barnieh L, Bailey JJ, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, Manns B. Patient navigators for people with chronic disease: A systematic review. PLoS One. 2018 Feb 20;13(2):e0191980. doi: 10.1371/journal.pone.0191980. eCollection 2018.
- Ali-Faisal SF, Colella TJ, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. Patient Educ Couns. 2017 Mar;100(3):436-448. doi: 10.1016/j.pec.2016.10.014. Epub 2016 Oct 17.
- Walkinshaw E. Patient navigators becoming the norm in Canada. CMAJ. 2011 Oct 18;183(15):E1109-10. doi: 10.1503/cmaj.109-3974. Epub 2011 Sep 19. No abstract available.
- Desveaux L, McBrien K, Barnieh L, Ivers NM. Mapping variation in intervention design: a systematic review to develop a program theory for patient navigator programs. Syst Rev. 2019 Jan 8;8(1):8. doi: 10.1186/s13643-018-0920-5.
- Shommu NS, Ahmed S, Rumana N, Barron GR, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. Int J Equity Health. 2016 Jan 15;15:6. doi: 10.1186/s12939-016-0298-8.
- Gutierrez Kapheim M, Campbell J. Best Practice Guidelines for Implementing and Evaluating Community Health Worker Programs in Health Care Settings. Sinai Urban Health Institute; Chicago, IL. 2014.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Glucose Metabolism Disorders
- Metabolic Diseases
- Respiratory Tract Diseases
- Arteriosclerosis
- Arterial Occlusive Diseases
- Lung Diseases
- Urologic Diseases
- Endocrine System Diseases
- Diabetes Mellitus
- Renal Insufficiency
- Coronary Disease
- Heart Failure
- Heart Diseases
- Coronary Artery Disease
- Myocardial Ischemia
- Diabetes Mellitus, Type 2
- Kidney Diseases
- Renal Insufficiency, Chronic
- Lung Diseases, Obstructive
- Pulmonary Disease, Chronic Obstructive
Other Study ID Numbers
- REB20-0009
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 Hypertension
-
National Taiwan University Hospital Hsin-Chu BranchRecruitingHypertension,Essential | Hypertension, MaskedTaiwan
-
University of Alabama at BirminghamTroy UniversityCompletedHypertension | Hypertension, Resistant to Conventional Therapy | Uncontrolled Hypertension | Hypertension, White CoatUnited States
-
BayerCompletedPrimary HypertensionChina
-
Addpharma Inc.Completed
-
Columbia UniversityAgency for Healthcare Research and Quality (AHRQ)Active, not recruitingWhite Coat Hypertension | Hypertension,EssentialUnited States
-
Universidade Federal de Santa MariaCompletedHealthy Volunteers | Hypertension, EssentialBrazil
-
Sulaiman AlRajhi CollegesUnknownHypertension, Essential | β-hydroxybutyrate
-
Centre Chirurgical Marie LannelongueUnknownChronic Thrombo-embolic Pulmonary Hypertension and Pulmonary Arterial HypertensionFrance
-
Sheffield Teaching Hospitals NHS Foundation TrustUniversity of SheffieldCompletedIdiopathic Pulmonary Arterial Hypertension | Chronic Thromboembolic Pulmonary HypertensionUnited Kingdom
Clinical Trials on Community Health Navigator Program
-
University of CalgaryUniversity of AlbertaActive, not recruitingHypertension | Diabetes Mellitus, Type 2 | Chronic Kidney Diseases | Chronic Obstructive Pulmonary Disease | Asthma | Ischemic Heart Disease | Congestive Heart FailureCanada
-
University of CalgaryUniversity of AlbertaActive, not recruitingHypertension | Diabetes Mellitus, Type 2 | Chronic Kidney Diseases | Chronic Obstructive Pulmonary Disease | Asthma | Ischemic Heart Disease | Congestive Heart FailureCanada
-
University of California, Los AngelesNot yet recruitingSocial Isolation
-
University of California, San FranciscoSeva Foundation; Bharatpur Eye HospitalCompletedGlaucoma | Diabetic Retinopathy | Refractive Errors | Cataract | Age Related Macular DegenerationNepal
-
Brigham and Women's HospitalEastern Research GroupCompletedHypertension | Diabetes Mellitus | Metabolic Syndrome | Chronic DiseaseUnited States
-
Last Mile HealthMassachusetts General Hospital; Northwestern University; Georgetown University; Heidelberg UniversityActive, not recruitingDiarrhea | Malaria | Acute Respiratory Infection | Malnutrition, ChildLiberia
-
University of ConnecticutCompletedCognitive DysfunctionUnited States
-
Jonsson Comprehensive Cancer CenterRecruitingBreast Carcinoma | Lung CarcinomaUnited States
-
International Care Ministries, PhilippinesUniversity of Toronto; University of WaterlooRecruitingChild MalnutritionPhilippines
-
Fred Hutchinson Cancer CenterNational Cancer Institute (NCI)Not yet recruiting