- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05203471
Crossing the Divide: Piloting Integrated Care to Reduce Amputations Among Rural Patients With Diabetic Foot Ulcers
October 10, 2023 updated by: University of Wisconsin, Madison
Crossing the Divide: Piloting an Integrated Care Model to Bridge Rural-urban Healthcare Systems and Reduce Major Amputations Among Rural Patients With Diabetic Foot Ulcers
This project directly addresses the escalating national rate of major (above-ankle) amputations due to diabetic foot ulcers; it focuses on rural patients, who face 37% higher odds of major amputation compared to their urban counterparts.
The project pilots the first integrated care model adapted to rural settings, an approach that has reduced major amputations in urban settings by approximately 40%.
Pilot data will be used to improve recruitment and retention strategies and provide preliminary evidence of efficacy needed to conduct a robust, statewide efficacy trial.
Study Overview
Status
Enrolling by invitation
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
237
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: Jamie LaMantia
- Phone Number: 608-262-8316
- Email: jnlamantia@medicine.wisc.edu
Study Locations
-
-
Wisconsin
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Madison, Wisconsin, United States, 53705
- University of Wisconsin-Madison
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Contact:
- Meghan B Brennan, MD
- Phone Number: 608-263-1545
- Email: mbbrennan@medicine.wisc.edu
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Principal Investigator:
- Meghan B Brennan, 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 to 89 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
Healthcare worker inclusion criteria:
- Willing to provide informed consent
- Willing to comply with study procedures
- Rural providers (primary care physicians at the UW Health Belleville Family Medicine Clinic, diabetes and wound care specialists at Sauk Prairie Healthcare Diabetes and Wound Care Clinic) and schedulers placing referrals.
- Employed at a participating clinic
- For rural providers, confirm understanding that they will retain clinical discretion to deviate from the integrated care model if they think it would best serve the patient.
- Available for the duration of the study
Patient inclusion criteria:
- Able and willing to provide informed consent.
- Willing to comply with study procedures and be available for the duration of the study.
- 18 years of age and older.
- Patient with either type 1 or type 2 diabetes at a participating rural clinic.
- Develops diabetic foot ulcer during enrollment period.
Exclusion Criteria:
Healthcare worker exclusion criteria:
- Insufficient overlap in work schedules between rural providers and scheduler based on clinic manager determination.
Patient exclusion criteria:
- receiving palliative care such that referral to urban centers for aggressive limb salvage would be inappropriate, as assessed by patient rural provider
- insurance does not cover referral to the University of Wisconsin's specialty clinics
- Not suitable for study participation due to other reasons at the discretion of the investigators.
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: Non-Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Historical controls
Patients with diabetic foot ulcers cared for by a primary care provider participating in the study prior to launching the integrated care intervention.
|
|
Active Comparator: Integrated care
Patients with diabetic foot ulcers cared for by a primary care provider participating in the study after launching the integrated care intervention.
Only patients who provide informed consent and enroll in the study will be treated with our integrated care model.
All other patients with a participating primary care provider will be treated using a standard care model and will not be considered study participants.
|
The investigators are piloting an integrated care model for rural patients with diabetic foot ulcers.
The model uses two tools to promote collaboration between providers: a care algorithm and a referral checklist.
The care algorithm will be used by rural primary care providers to guide integrated care addressing glycemic control, vascular disease, wound care, and infection.
The referral checklist will be used by rural schedulers who place referrals to urban specialists.
It prompts schedulers to fax appropriate supporting documents (e.g.
notes, labs, vascular testing results) with the referral request.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients receiving guideline-concordant vascular and infectious disease care processes
Time Frame: up to 2 years and 3 months
|
(proportion of integrated care patients receiving guideline-concordant vascular and infectious disease care within 3 months of their enrollment) minus (the proportion of historical patients receiving guideline-concordant vascular and infectious disease care within 3 months of participant enrollment)
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up to 2 years and 3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients undergoing amputation
Time Frame: up to 2 years and 3 months
|
(proportion of integrated care patients undergoing amputation within 3 months of their enrollment) minus (proportion of historical patients undergoing amputation within 3 months of their enrollment), where amputation is defined as major or minor amputation of the ipsilateral lower extremity to the index ulcer
|
up to 2 years and 3 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient recruitment rate
Time Frame: up to 2 years and 3 months
|
Number of patients who enrolled in the study divided by the number of patients the study team attempted to contact for study recruitment
|
up to 2 years and 3 months
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Patient retention rate
Time Frame: up to 2 years and 3 months
|
Number of patients who completed the 3-month follow-up telephone call divided by the number of patients who enrolled in the study
|
up to 2 years and 3 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Meghan B Brennan, MD, University of Wisconsin, Madison
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)
February 16, 2023
Primary Completion (Estimated)
October 1, 2024
Study Completion (Estimated)
October 1, 2024
Study Registration Dates
First Submitted
January 10, 2022
First Submitted That Met QC Criteria
January 10, 2022
First Posted (Actual)
January 24, 2022
Study Record Updates
Last Update Posted (Actual)
October 12, 2023
Last Update Submitted That Met QC Criteria
October 10, 2023
Last Verified
October 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022-1338
- R01DK132569-01 (U.S. NIH Grant/Contract)
- SMPH/MEDICINE/INFECT DIS (Other Identifier: UW Madison)
- Protocol Version 9/18/2023 (Other Identifier: UW Madison)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Individual participant data collected during the study, after de-identification will be available to researchers for independent verification of study outcomes or to conduct subsequent clinical research, whose proposed use of the data has been approved by an independent review committee identified for this purpose.
IPD Sharing Time Frame
Beginning 9 months after publication of primary outcomes and ending 5 years after that date.
IPD Sharing Access Criteria
Proposals should be directed to the PI, Dr. Meghan Brennan (mbbrennan@medicine.wisc.edu).
If approved after review by regulatory counsel, requestors will enter into a formal data sharing agreement.
Data will be shared via encrypted single-user file transmission protocol.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
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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