Program for Research on the Outcomes of VA Education (PROVE)
tiistai 1. toukokuuta 2018 päivittänyt: Mark Schwartz, VA New York Harbor Healthcare System
Program for Research on the Outcomes of VA Education: Controlled Study of Panel Management and Microsystem Education Interventions to Improve Outcomes in Hypertension and Smoking Cessation
The PROVE aims to test the efficacy of panel management support and educational intervention in VA Primary Care Clinical Microsystems.
The study will test three increasingly intensive methods for implementing panel management strategies among health care providers in VA primary care clinics: providing only panel data, providing panel management support, and providing support plus clinical microsystem-enhancing education and training.It is hypothesized that the group receiving panel management and educational interventions will have better smoking cessation and hypertension outcomes than the group receiving only panel management assistance.
It is further supposed that the later will have better smoking cessation and hypertension patient outcomes than the data-only group.
Tutkimuksen yleiskatsaus
Tila
Valmis
Interventio / Hoito
Yksityiskohtainen kuvaus
Objective:
The specific aims for this study are: (1) to identify health professional educational and clinical microsystem determinants of outcomes for hypertension and smoking cessation in veterans. (2) to test the efficacy of three increasingly intensive methods for implementing panel management strategies among health care providers in VA primary care clinics: providing only panel data, providing panel management support, and providing support plus clinical microsystem-enhancing education and training.
Research design:
This project will consist of two phases. Phase I (one year) is the development of the necessary measurement and data infrastructure to assess health professional education, microsystem function, and clinical outcomes. In Phase 2 (two years) the study team will conduct a clinical demonstration project, comparing three interventions in a randomized controlled trial. Primary care teams will be randomly allocated to one of three arms: 1) panel management data, 2) panel management data and support, and 3) panel management data, support and education. The investigators will assess the impact of the implementation of panel management on primary patient outcomes in hypertension and smoking cessation (blood pressure and quit rates). The investigative team will also assess the impact of the implementation of panel management on secondary, intermediary, patient (patient activation, adherence, behavior change), provider (knowledge and attitudes, self-efficacy, job satisfaction) and microsystem outcomes (collective efficacy, teamwork, use of data, redesign of patient processes and provider roles/responsibilities, use of panel management strategies).
Methodology:
The study will utilize a multi-method, quasi-experimental design at VA NYHHS. Primary care is delivered through two teams at the Manhattan and five teams at the Brooklyn campuses. Patients, staff, nurses, and physicians are assigned to specific teams, thereby limiting contamination in this study.
Opintotyyppi
Interventio
Ilmoittautuminen (Todellinen)
5000
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.
Opiskelupaikat
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New York
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Brooklyn, New York, Yhdysvallat, 11209
- VA NYHHS Brooklyn Campus
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New York, New York, Yhdysvallat, 10010
- VA NYHHS Manhattan Campus
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Osallistumiskriteerit
Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Lapsi
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Joo
Sukupuolet, jotka voivat opiskella
Kaikki
Kuvaus
Inclusion Criteria:
- non-specialized primary care clinical microsystems
Exclusion Criteria:
- specialized clinical microsystems
- pilot clinical patient-aligned care teams
Opintosuunnitelma
Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Terveyspalvelututkimus
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
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Active Comparator: PM-Data
Team will receive data only.
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The microsystem teams of providers, nurses, and clerks will receive monthly reports of their performance measures, which will include process and outcome data for smoking cessation and blood pressure control for veterans in their panel.
The reports will provide lists of individual patients in the panel with unmet goals on VA performance measures.
They will receive written informational material describing principles and practices of panel management and evidence-based guidelines for hypertension management and smoking cessation.
|
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Kokeellinen: PM-Support
Team will receive data and panel management support
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The microsystem teams of providers, nurses, and clerks will receive monthly reports of their performance measures, which will include process and outcome data for smoking cessation and blood pressure control for veterans in their panel.
The reports will provide lists of individual patients in the panel with unmet goals on VA performance measures.
They will receive written informational material describing principles and practices of panel management and evidence-based guidelines for hypertension management and smoking cessation.
PMAs will meet regularly with the members of the microsystem team for one hour/week.
The team will be asked to review progress on the health status of their patient panel and to plan strategies for improving their outcomes that the PMA will then implement.
A PMA toolkit of panel management strategies will be established that will include guidelines for using VA databases to identify care gaps and reaching out to panel patients via phone and mail to intervene (e.g.
reconnect patients to care with appointments, assess and enhance medication adherence, connect patients with VA services, motivational interviewing, and communication with the team about patient issues.
Muut nimet:
|
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Kokeellinen: PM-Education
Team will receive data, panel management support, and educational interventions.
|
The microsystem teams of providers, nurses, and clerks will receive monthly reports of their performance measures, which will include process and outcome data for smoking cessation and blood pressure control for veterans in their panel.
The reports will provide lists of individual patients in the panel with unmet goals on VA performance measures.
They will receive written informational material describing principles and practices of panel management and evidence-based guidelines for hypertension management and smoking cessation.
PMAs will meet regularly with the members of the microsystem team for one hour/week.
The team will be asked to review progress on the health status of their patient panel and to plan strategies for improving their outcomes that the PMA will then implement.
A PMA toolkit of panel management strategies will be established that will include guidelines for using VA databases to identify care gaps and reaching out to panel patients via phone and mail to intervene (e.g.
reconnect patients to care with appointments, assess and enhance medication adherence, connect patients with VA services, motivational interviewing, and communication with the team about patient issues.
Muut nimet:
The educational intervention will be administered throughout the duration of the study.
Our initial educational focus will be on content (concepts of population health and panel management) and process (practice change methodology).
Subsequent education will be process oriented, reviewing the changing system of care and discussing its functioning.
Education will cover panel management strategies, microsystem theory and skills, and specific strategies regarding the management of hypertension and smoking cessation.
It will include monthly seminars, reading materials, web-based modules, and skill building workshops, and PMA-conducted monthly academic detailing using panel data and feedback.
After the first three months, academic detailing will only be implemented on an as-needed basis.
Muut nimet:
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Change in Smoking Status
Aikaikkuna: Baseline and 12 months
|
clinical outcome
|
Baseline and 12 months
|
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Change in Blood Pressure Reading
Aikaikkuna: Baseline and 12 months
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clinical outcome
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Baseline and 12 months
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Change in weight
Aikaikkuna: Baseline and most recent at 12 months
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Baseline and most recent at 12 months
|
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Change in Patient Activation
Aikaikkuna: 6 months and 12 months
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The Patient Activation Measure (PAM) is used to assess patients' self-reported knowledge, skill, and confidence in self-managing of health and chronic conditions
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6 months and 12 months
|
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Change in Patient Perceptions of Quality of Care
Aikaikkuna: 6 months and 12 months
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6 months and 12 months
|
|
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Change in Provider Behavior change expertise
Aikaikkuna: 6 months and 12 months
|
6 months and 12 months
|
|
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Change in Provider Self-efficacy with Panel Management Tasks
Aikaikkuna: Baseline and 12 months
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Baseline and 12 months
|
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Change in Provider Job Satisfaction
Aikaikkuna: Baseline and 12 months
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Baseline and 12 months
|
|
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Change in Microsystem function and collective efficacy
Aikaikkuna: Baseline and 12 months
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Baseline and 12 months
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Change in Provider's assessments of training that they received in panel management and working within a PACT team
Aikaikkuna: Baseline and 12 months
|
Baseline and 12 months
|
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Change in Proportion of panel smokers offered smoking cessation resources by study arm
Aikaikkuna: Baseline and 12 months
|
Baseline and 12 months
|
|
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Change in Proportion of smokers on the panel received any cessation medications
Aikaikkuna: Baseline and 12 months
|
This information will be culled from the Vista Smoking Database
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Baseline and 12 months
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Muut tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Change in Health care usage
Aikaikkuna: Baseline and 12 months
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Number of primary care visits, mental health visits, emergency room/urgent care visits and the number of VA hospitalizations
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Baseline and 12 months
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Change in Patient-level costs
Aikaikkuna: Baseline and 12 months
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Outpatient primary care visits, mental health visits, pharmacy and hospitalizations from the VA Decision Support System
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Baseline and 12 months
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Yhteistyökumppanit ja tutkijat
Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.
Sponsori
Tutkijat
- Päätutkija: Mark D Schwartz, VA New York Harbor Healthcare System
- Päätutkija: Scott Sherman, M.D., M.P.H., VA New York Harbor Healthcare System
- Opintojohtaja: Colleen Gillespie, PhD, NYU Langone Health
- Opintojohtaja: Anne Dembitzer, M.D., VA New York Harbor Healthcare System
Julkaisuja ja hyödyllisiä linkkejä
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Opintojen ennätyspäivät
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Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Tiistai 1. syyskuuta 2009
Ensisijainen valmistuminen (Todellinen)
Sunnuntai 31. elokuuta 2014
Opintojen valmistuminen (Todellinen)
Maanantai 31. elokuuta 2015
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Tiistai 28. elokuuta 2012
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Keskiviikko 29. elokuuta 2012
Ensimmäinen Lähetetty (Arvio)
Maanantai 3. syyskuuta 2012
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Maanantai 7. toukokuuta 2018
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Tiistai 1. toukokuuta 2018
Viimeksi vahvistettu
Tiistai 1. toukokuuta 2018
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
- EDU 08-428-2
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