- ICH GCP
- Rejestr badań klinicznych w USA
- Badanie kliniczne NCT01972308
A Patient Advocate to Improve Real-world Asthma Management for Inner City Adults (HAP2)
Przegląd badań
Status
Warunki
Interwencja / Leczenie
Szczegółowy opis
This 5 year project tests the effectiveness, sustainability, and budget impact of a patient navigator intervention to facilitate and maintain patient-provider communication and access to chronic care of moderate or severe asthma in low income minority adults with other chronic morbidities. We will recruit from a variety of clinic practices including those of an urban academic health center, a VA, and a federally qualified health center and in both English-speaking and Spanish-speaking patients. The intervention is tailored to patients and their clinics, and informed by focus groups of patients and providers.
The Patient Advocate (PA), works with patients by coaching and modeling preparation for a visit with the asthma doctor, attending the visit with the permission of participant and provider, and confirming understanding of issues discussed. The PA also facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to carrying out medical advice, and exchange of information between providers and patients. The PAs are recent college graduates interested in health-related or education careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential subjects.
This dissemination and implementation project refines the intervention of RC1 HL099612 for real-world practice by 1) conducting a randomized controlled trial that compares the Patient Advocate Intervention (PAI) to currently practiced guideline-based usual care; 2) carrying out the intervention in a variety of primary care and asthma specialty practices; 3) extending the observation time to a year to test its sustainability; 4) assessing patient-centered outcomes including asthma control, quality of life, ED visits, and hospitalizations; 5) assessing mediators/moderators of the PAI-asthma outcome relationship; and 6) evaluating its cost-effectiveness.
We will recruit 300 adults, each to be followed for at least 1 year with moderate or severe persistent asthma from clinics serving low-income, urban, primarily minority patients and conduct a randomized controlled trial (RCT) to: 1) assess whether 6 months of the PAI improves asthma control relative to baseline compared with usual care (UC) and whether such a difference is sustained in the 6 months following the intervention's completion, 2) Assess whether the PAI improves other asthma outcomes (need for prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline compared with UC at 6 months and is sustained in the 6 months following the intervention's completion, 3) examine mediators and moderators of the relationship between the intervention and outcome, 4) assess the incremental direct and indirect costs of the PAI compared to usual care and the cost-effectiveness of the PAI relative to UC for the outcomes, and 5) in post-study focus groups of providers to explore awareness of the intervention and response to the PA
Typ studiów
Zapisy (Rzeczywisty)
Faza
- Nie dotyczy
Kontakty i lokalizacje
Lokalizacje studiów
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Pennsylvania
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Philadelphia, Pennsylvania, Stany Zjednoczone, 19104
- University of Pennsylvania Health System
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Kryteria uczestnictwa
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
Inclusion Criteria:
- > 18 years of age,
- physician's diagnosis of asthma,
- prescribed an inhaled-steroid-containing medication for asthma (ensuring the patient is believed to have moderate or severe reversible airways obstruction by their physician),
- moderate or severe persistent asthma according to the NHLBI Guidelines,
- evidence of reversible airflow obstruction: (a) forced expiratory volume in 1 second (FEV1) < 80% predicted at the time of screening or within the 3 years prior to this screening, and (b) improvement with bronchodilator: either (i) an increase of >15% and 200ml in FEV1 with asthma treatment over the previous 3 years or (ii) after 4 puffs of albuterol by MDI (or 2.5 mg by nebulizer), an increase in FEV1 or FVC >12% and 200 ml in FEV1 within 30 minutes,
- at least one appointment scheduled with the asthma physician during the 1st 6 months of participation
Exclusion Criteria:
- Severe psychiatric or cognitive problems (e.g., obvious mania, schizophrenia, significant mental retardation) that make it impossible to understand and carryout PA activities.
- Unable to understand and provide informed consent,
- Unable to communicate in English or Spanish.
- Participants of the pilot study for this project are excluded
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Badania usług zdrowotnych
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Pojedynczy
Broń i interwencje
Grupa uczestników / Arm |
Interwencja / Leczenie |
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Eksperymentalny: Patient advocate
Subject works with a Patient Advocate who coaches, models, and assists with preparations for a visit with the asthma doctor; attends the visit with permission of participant and provider; and confirms understanding.
The PA facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to carrying out medical advice, and transfer of information between providers and patients.
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Subject works with a Patient Advocate who coaches, models, and assists with preparations for a visit with the asthma doctor; attends the visit with permission of participant and provider; and confirms understanding.
The PA facilitates scheduling, obtaining insurance coverage, overcoming patients' unique social and administrative barriers to accomplishing medical advice, and transfer of information between provider and patient.
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Inny: usual care
Patient receives asthma care as usual from their asthma provider
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Subjects receive asthma care from their proivders in the participating practices which generally follow asthma guidelines
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Co mierzy badanie?
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
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Change in Asthma Control at One Year
Ramy czasowe: baseline and 1 year
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Asthma Control Questionnaire: In a randomized controlled trial we will assess whether 6 months of the Patient Advocate Intervention improves asthma control relative to baseline compared with usual care (UC) and whether such a difference is sustained in the 6 months following the intervention's completion. Asthma Control range is 0-6 with lower score better control (0= total control and 6 = extremetly uncontrolled. The minimally important clinical difference is 0.5. A score > 1.5 is considered inadequate control. |
baseline and 1 year
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Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
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Change in Emergency Department(ED) Visits at One Year
Ramy czasowe: one year
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Emergency room visits in the 6 months before entry compared with emergency room visits in the 6 months prior to the one year timepoint
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one year
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Change in Asthma-related Quality of Life
Ramy czasowe: baseline to one year
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Asthma-related quality of life will be measured with the Mini-Asthma Quality of Life Questionnaire (AQLQ).
This 15-item questionnaire with each item having a 7-point response scale that provides a mean summary score.
A 0.5-unit change is considered clinically meaningful.
the range is 1 - 7 with higher score better quality of life.
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baseline to one year
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Change in Hospitalizations
Ramy czasowe: one year
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Participants will report hospitalizations verified if possible in participating health systems.
We review records and if not available ask patient for hospititalizations over the 6 months before baseline and compare it with the record or report in the 6-months prior to one year.
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one year
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Risk of Prednisone Bursts
Ramy czasowe: baseline and one year
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a new dose or an increase in already prescribed prednisone dose
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baseline and one year
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Change in Urgent Office Visit
Ramy czasowe: one year
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Records or if not available patient report of an urgent office visit in the 6 months before baseline compared with record or report of urgent office visits in the 6 months prior to one year.
An urgent office visit is one scheduled within 24 hours of the visit.
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one year
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Współpracownicy i badacze
Sponsor
Śledczy
- Główny śledczy: Andrea J Apter, MD, University of Pennsylvania
Publikacje i pomocne linki
Publikacje ogólne
- Apter AJ, Wan F, Reisine S, Bogen DK, Rand C, Bender B, Bennett IM, Gonzalez R, Priolo C, Sonnad SS, Bryant-Stephens T, Ferguson M, Boyd RC, Ten Have T, Roy J. Feasibility, acceptability and preliminary effectiveness of patient advocates for improving asthma outcomes in adults. J Asthma. 2013 Oct;50(8):850-60. doi: 10.3109/02770903.2013.812655. Epub 2013 Jul 17.
- Apter AJ, Wan F, Reisine S, Bender B, Rand C, Bogen DK, Bennett IM, Bryant-Stephens T, Roy J, Gonzalez R, Priolo C, Have TT, Morales KH. The association of health literacy with adherence and outcomes in moderate-severe asthma. J Allergy Clin Immunol. 2013 Aug;132(2):321-7. doi: 10.1016/j.jaci.2013.02.014. Epub 2013 Apr 13.
- Apter AJ, Bryant-Stephens T, Morales KH, Wan F, Hardy S, Reed-Wells S, Dominguez M, Gonzalez R, Mak N, Nardi A, Park H, Howell JT, Localio R. Using IT to improve access, communication, and asthma in African American and Hispanic/Latino Adults: Rationale, design, and methods of a randomized controlled trial. Contemp Clin Trials. 2015 Sep;44:119-128. doi: 10.1016/j.cct.2015.08.001. Epub 2015 Aug 8.
- Bryant-Stephens T, Reed-Wells S, Canales M, Perez L, Rogers M, Localio AR, Apter AJ. Home visits are needed to address asthma health disparities in adults. J Allergy Clin Immunol. 2016 Dec;138(6):1526-1530. doi: 10.1016/j.jaci.2016.10.006. Epub 2016 Oct 21.
- Kramer CB, LeRoy L, Donahue S, Apter AJ, Bryant-Stephens T, Elder JP, Hamilton WJ, Krishnan JA, Shelef DQ, Stout JW, Sumino K, Teach SJ, Federman AD. Enrolling African-American and Latino patients with asthma in comparative effectiveness research: Lessons learned from 8 patient-centered studies. J Allergy Clin Immunol. 2016 Dec;138(6):1600-1607. doi: 10.1016/j.jaci.2016.10.011. Epub 2016 Oct 24.
- Apter AJ, Perez L, Han X, Ndicu G, Localio A, Park H, Mullen AN, Klusaritz H, Rogers M, Cidav Z, Bryant-Stephens T, Bender BG, Reisine ST, Morales KH. Patient Advocates for Low-Income Adults with Moderate to Severe Asthma: A Randomized Clinical Trial. J Allergy Clin Immunol Pract. 2020 Nov - Dec;8(10):3466-3473.e11. doi: 10.1016/j.jaip.2020.06.058. Epub 2020 Jul 14.
- Korwin A, Black H, Perez L, Morales KH, Klusaritz H, Han X, Huang J, Rogers M, Ndicu G, Apter AJ. Exploring Patient Engagement: A Qualitative Analysis of Low-Income Urban Participants in Asthma Research. J Allergy Clin Immunol Pract. 2017 Nov - Dec;5(6):1625-1631.e2. doi: 10.1016/j.jaip.2017.03.022. Epub 2017 May 10.
- Buckey TM, Morales KH, Apter AJ. Understanding Autonomy in Patients with Moderate to Severe Asthma. J Allergy Clin Immunol Pract. 2022 Feb;10(2):525-533. doi: 10.1016/j.jaip.2021.10.068. Epub 2021 Nov 14.
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów (Rzeczywisty)
Zakończenie podstawowe (Rzeczywisty)
Ukończenie studiów (Rzeczywisty)
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Oszacować)
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
- 1R18HL116285-01 (Grant/umowa NIH USA)
Te informacje zostały pobrane bezpośrednio ze strony internetowej clinicaltrials.gov bez żadnych zmian. Jeśli chcesz zmienić, usunąć lub zaktualizować dane swojego badania, skontaktuj się z register@clinicaltrials.gov. Gdy tylko zmiana zostanie wprowadzona na stronie clinicaltrials.gov, zostanie ona automatycznie zaktualizowana również na naszej stronie internetowej .
Badania kliniczne na Patient Advocate
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University of Illinois at ChicagoRekrutacyjnyRak szyjki macicy | ZachowanieSenegal
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University of Colorado, DenverNational Institute of Nursing Research (NINR); Kaiser Permanente; Denver Health...ZakończonyOpieka paliatywnaStany Zjednoczone
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Ohio State University Comprehensive Cancer CenterRekrutacyjnyAnatomiczny rak piersi w stadium I AJCC v8 | Rak piersi w stadium anatomicznym IA AJCC v8 | Rak piersi w stadium anatomicznym IB AJCC v8 | Anatomiczny rak piersi w stadium II AJCC v8 | Rak piersi w stadium anatomicznym IIA AJCC v8 | Rak piersi w stadium anatomicznym IIB AJCC v8 | Anatomiczny rak piersi... i inne warunkiStany Zjednoczone
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Brigham and Women's HospitalPatient-Centered Outcomes Research InstituteAktywny, nie rekrutującyOtyłość | NadwagaStany Zjednoczone
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Fred Hutchinson Cancer CenterNational Cancer Institute (NCI)Jeszcze nie rekrutacja
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University of California, San FranciscoBristol-Myers Squibb FoundationZakończonyRak płuc w stadium III AJCC v8 | Rak płuc w stadium II AJCC v8 | Rak płuca w stadium IIA AJCC v8 | Rak płuca w stadium IIB AJCC v8 | Rak płuc w stadium IIIA AJCC v8 | Rak płuc w stadium IIIB AJCC v8 | Nowotwór złośliwy | Rak jelita grubego w stadium III AJCC v8 | Stadium IIIA Rak jelita grubego AJCC v8 | Stadium... i inne warunkiStany Zjednoczone
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Brigham and Women's HospitalNational Institutes of Health (NIH); National Library of Medicine (NLM)NieznanyNowotwór | Utrata słuchu | Kardiomiopatia przerostowaStany Zjednoczone, Kanada
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The Christie NHS Foundation TrustManchester University NHS Foundation Trust; Aptus Clinical Ltd.; Zenzium Ltd.Zakończony
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Jonsson Comprehensive Cancer CenterRekrutacyjnyRak piersi | Rak płucStany Zjednoczone
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Ohio State University Comprehensive Cancer CenterAmerican Cancer Society, Inc.ZakończonyRak szyjki macicy | Rak piersi | Rak odbytnicy | Rak jelita grubego | Nieprawidłowe testy przesiewowe w kierunku raka piersi | Nieprawidłowe testy przesiewowe w kierunku raka szyjki macicy | Nieprawidłowe testy przesiewowe w kierunku raka okrężnicyStany Zjednoczone