Effectiveness of Patient-centered Community Health Worker Support to Help Patients Control Chronic Disease
2017年5月2日 更新者:University of Pennsylvania
Community Health Worker Support to Help Patients Control Chronic Disease
The purpose of this proposal is to compare the effectiveness of community health worker (CHW) support vs. usual primary care for helping chronically-ill, low-SES patients to improve control of chronic conditions.
Upon enrollment each patient will select one of their multiple chronic conditions as a focus for the trial and work with his/her PCP to set a chronic disease management goal.
Patients are then randomized to receive usual primary care vs. CHW support for moving towards that goal.
調査の概要
研究の種類
介入
入学 (実際)
302
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
-
-
Pennsylvania
-
Philadelphia、Pennsylvania、アメリカ、19104
- University of Pennsylvania
-
-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
- 子
- 大人
- 高齢者
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- Patient of target practices for at least 1 yr defined as having one office visit within preceding 12 month
- Home ZIP code including ANY of the following: 1. 19104 2. 19131 3. 19139 4. 19143 5. 19146
- 2 or more of the following conditions: 1. Obesity (BMI greater than 30), 2. HTN (ICD9 relating to HTN in EMR), 3. DM (ICD9 relating to DM in EMR), 4. Asthma/COPD and tobacco dependence (ICD9 for asthma or COPD in EMR AND documentation of tobacco use)
- Uninsured, insured by Medicaid or dually eligible for Medicaid/Managed Medicare
- Patients who have scheduled appointments in the future.
Exclusion Criteria:
- Will not provide informed consent for this study.
- Does not have the capacity to provide informed consent for this study.
- Previously enrolled in this study
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:単一グループの割り当て
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:CHW Goal Support
IMPaCT CHWs will perform the following functions, depending on the needs of the participants: 1) Deconstructing Distal Goals into Proximal Goals: IMPaCT CHWs will help patients to deconstruct collaborative distal clinical goals into patient driven proximal goals and develop strategies for achieving each proximal goal.2) Creating Roadmaps: Roadmaps are individualized strategies for achieving each proximal goal identified by patients.
3) IMPaCT CHWs conduct weekly follow-up with patients through either telephone or home visit in order to support the achievement of proximal goals.
As part of these followup encounters, CHWs ask patients to measure their chronic disease control during their weekly followup calls/visits.
4) Group: CHWs and their Project Manager run a group session for patients in the IMPaCT arm.
This group meets weekly and is a forum for patients to discuss common issues around chronic disease management and form a social support network.
|
IMPaCT CHWs will perform the following functions, depending on the needs of the participants: 1) Deconstructing Distal Goals into Proximal Goals: IMPaCT CHWs will help patients to deconstruct collaborative distal clinical goals into patient driven proximal goals and develop strategies for achieving each proximal goal.2) Creating Roadmaps: Roadmaps are individualized strategies for achieving each proximal goal identified by patients.
3) IMPaCT Partners conduct weekly follow-up with patients through either telephone or home visit in order to support the achievement of proximal goals.
As part of these followup encounters, CHWs ask patients to measure their chronic disease control during their weekly followup calls/visits.
4) Group: CHWs and their Project Manager run a group session for patients in the IMPaCT arm.
This group meets weekly and is a forum for patients to discuss common issues around chronic disease management and form a social support network.
他の名前:
|
介入なし:Usual Primary Care
Patients will be encouraged to make follow-up appointments as needed with their primary care clinic for support towards their health goals.
During these appointments, clinicians will help patients determine progress made on existing proximal goals, adjust goals based on self-efficacy, and help patients to create new proximal goals as needed.
They will also work with PCPs to adjust medications when appropriate, provide health behavior education and make referrals to community-based services based on patient need.
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Change in standardized score
時間枠:Six months after enrollment
|
Six months after enrollment, the IMPaCT arm will have a higher (more negative) mean change in standardized score for chronic disease outcome of interest compared with usual care
|
Six months after enrollment
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Goal achievement
時間枠:Six months after enrollment
|
Six months after enrollment, patients in the IMPaCT group will have higher proportion of patients who achieve their individualized chronic disease management goal compared with usual care
|
Six months after enrollment
|
SF-12
時間枠:Six months after enrollment,
|
Six months after enrollment, patients in the IMPaCT group will greater improvements in their self-rated health (as measured by mean change in MCS and PCS of the SF-12) than patients receiving usual care.
|
Six months after enrollment,
|
CAHPS PCMH (Communication, Self-Management Support, Comprehensiveness of Care)
時間枠:Six months after enrollment
|
Six months after enrollment, the IMPaCT arm will have higher perceived quality of patient-centered medical care (as measured by the Consumer Assessment of Healthcare Providers and Systems Patient-Centered Medical Home (CAHPS PCMH) survey) than the usual care arm.
Specifically, we will measure the CAHPS PCMH domains pertaining to Self-Management Support and Comprehensiveness of Care.
|
Six months after enrollment
|
Hospitalization
時間枠:6 months after enrollment
|
Patients in the IMpaCT arm with have a lower rate of hospitalizations than the usual care arm at 6 months after enrollment.
|
6 months after enrollment
|
Patient Activation
時間枠:Six months after enrollment
|
Six months after enrollment, patients in the IMPaCT arm will have greater improvements in their activation (as measured by mean change in PAM score) compared with patients in the usual care arm.
|
Six months after enrollment
|
その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Hospitalizations at 12 months
時間枠:12 months after enrollment
|
Patients in the IMpaCT arm with have a lower rate of hospitalizations than the usual care arm at 12 months after enrollment.
|
12 months after enrollment
|
Medical Adherence
時間枠:Six months after enrollment
|
Six months after enrollment, patients in the IMPaCT arm will have higher levels of adherence to medical recommendations than the usual care arm, as measured by the Medical Outcomes Study (MOS) Measures of Patient Adherence.
|
Six months after enrollment
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
捜査官
- 主任研究者:Shreya Kangovi、University of Pennsylvania
出版物と役立つリンク
研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。
一般刊行物
- 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.
- Kangovi S, Mitra N, Turr L, Huo H, Grande D, Long JA. A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol. Contemp Clin Trials. 2017 Feb;53:115-121. doi: 10.1016/j.cct.2016.12.009. Epub 2016 Dec 10.
- Kangovi S, Mitra N, Smith RA, Kulkarni R, Turr L, Huo H, Glanz K, Grande D, Long JA. Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial. Patient Educ Couns. 2017 Mar;100(3):449-455. doi: 10.1016/j.pec.2016.09.019. Epub 2016 Sep 25.
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2013年7月1日
一次修了 (実際)
2015年5月1日
研究の完了 (実際)
2017年2月1日
試験登録日
最初に提出
2013年7月11日
QC基準を満たした最初の提出物
2013年7月11日
最初の投稿 (見積もり)
2013年7月16日
学習記録の更新
投稿された最後の更新 (実際)
2017年5月3日
QC基準を満たした最後の更新が送信されました
2017年5月2日
最終確認日
2017年5月1日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
CHW Goal Supportの臨床試験
-
Rehaklinik Zihlschlacht AGLuzerner Kantonsspitalわからない
-
Ari Johnson, MDHarvard Medical School (HMS and HSDM); University of California, San Francisco; Malaria Research... と他の協力者完了地域医療従事者のパフォーマンス
-
University of MiamiHealth Choice Network; Center for Haitian Studies完了
-
University of Wisconsin, MadisonAgency for Healthcare Research and Quality (AHRQ)募集
-
Medical University of South CarolinaNational Center for Advancing Translational Sciences (NCATS)完了
-
Massachusetts General Hospitalまだ募集していません高血圧症 | 食糧不安 | 栄養、健康 | 地域医療従事者
-
University of FloridaNational Center for Advancing Translational Sciences (NCATS)まだ募集していません