Study protocol of "CHAPS": a randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson's Disease to improve the quality of care for individuals with Parkinson's disease

Karen Connor, Eric Cheng, Hilary C Siebens, Martin L Lee, Brian S Mittman, David A Ganz, Barbara Vickrey, Karen Connor, Eric Cheng, Hilary C Siebens, Martin L Lee, Brian S Mittman, David A Ganz, Barbara Vickrey

Abstract

Background: Parkinson's disease, the second most common neurodegenerative disease, is diagnostically defined by motor impairments, but also includes often under-recognized impairments in cognition, mood, sleep, and the autonomic nervous system. These problems can severely affect individuals' quality of life. In our prior research, we have developed indicators to measure the quality of care delivered to patients with Parkinson's disease, and we identified gaps in delivering evidence-based treatments for this population. Effective strategies to close these gaps are needed to improve patient quality of life.

Methods/design: Building on prior research we developed a multi-faceted proactive implementation program called Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS). To be eligible, patients had to have at least two visits with a primary diagnosis of idiopathic Parkinson's disease (ICD-9 code: 332.0) at one of five Veterans Affairs Medical Centers in the southwestern United States from 2010 to 2014. The program consists of telephone assessments, evidence-based protocols, and tools to enhance patient self-management, care planning, and coordination of care across providers, including an electronic database to support and track coordination of care. Our mixed-methods study employs a randomized, controlled trial design to test whether the CHAPS intervention improves performance in 38 quality measures among an analytic sample of 346 patients. The 38 quality measures are categorized into overarching areas of communication, education, and continuity; regulatory reporting; diagnosis; periodic assessment; medication use; management of motor and non-motor symptoms; use of non-pharmacological approaches and therapies; palliative care; and health maintenance. Secondary outcomes are patient health-related quality of life, self-efficacy, and perceptions of care quality. We are also evaluating the extent of the CHAPS Program implementation and measuring program costs and impacts on health services utilization, in order to perform a analysis of the CHAPS program from the perspective of the Veterans Health Administration (VA). Outcomes are assessed by interviewer-administered surveys collected at baseline and at 6, 12, and 18 months, and by medical record chart abstractions. Analyses will be intention-to-treat.

Discussion: The CHAPS Program is poised for dissemination within the VA National Parkinson's Disease Research, Education, and Clinical Center Consortium if demonstrated efficacious.

Trial registration: ClinicalTrials.gov NCT01532986; registered on January 13, 2012.

Figures

Fig. 1
Fig. 1
CHAPS Adaptation of the Chronic Care Model. Abbreviations: GLA—Greater Los Angeles; VAs—Veterans Health Administration; APDA—American Parkinson’s Disease Association; LA-CRC—Los Angeles Caregiver Resource Center; NPF—National Parkinson Foundation; PRO—Parkinson’s Resource Organization; CHAPS—Care Coordination for Health Promotion and Activities in Parkinson’s Disease; SDMM—Siebens Domain Management Model; SHC—Siebens Health Care
Fig. 2
Fig. 2
Study design and CHAPS Program intervention
Fig. 3
Fig. 3
Enrollment of subjects and schedule for collecting evaluation data
Fig. 4
Fig. 4
Enrollment sample sizes for achieving analytic sample sizes; range of effect sizes and retention rates

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