Intervention Protocol for Automated Point-of-Care Surveillance of Outpatient Delays in Cancer Diagnosis (PACT CREATE 3)
22 de fevereiro de 2018 atualizado por: VA Office of Research and Development
Automated Point-of-Care Surveillance of Outpatient Delays in Cancer Diagnosis
Many missed and delayed cancer diagnoses result from breakdowns in communication and coordination of abnormal findings suspicious for cancer, which often first emerge in the primary care setting. Delays in the follow-up of abnormal test results persist despite the reliable delivery of test results through the electronic health record.
This intervention is the final study in a three-phase project that will develop and test an innovative automated surveillance intervention to improve timely diagnosis and follow-up of five common cancers in primary care practice.
The investigators hypothesize that the median time in days from diagnostic clue to follow-up action (e.g. time to colonoscopy examination after am abnormal colon-related test) will be significantly less in the intervention arm than in usual care. The investigators also hypothesize that the proportion of patients receiving appropriate and timely follow-up care will be significantly higher in the intervention arm than in usual care.
Visão geral do estudo
Status
Retirado
Condições
Intervenção / Tratamento
Descrição detalhada
The CREATE Project encompasses three phases, the first and second of which do not contain interventions. The first phase of the project determines the effectiveness of computerized queries the investigators develop to accurately identify which patients are at risk for delays in cancer diagnosis. Patients the investigators identify will have abnormal test results or symptoms that have not been followed up by their providers. In Phase 2 of the study, the research team will use interviewing and other participatory techniques to determine the best way to convey information about such at-risk patients to providers in an automated fashion. In Phase 3 of the project, the investigators will evaluate the effects of an automated surveillance intervention on the timeliness of the diagnostic process of five cancers.
This project will improve communication and coordination of cancer-related diagnostic information to improve quality and safety.
Tipo de estudo
Intervencional
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
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Illinois
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Chicago, Illinois, Estados Unidos, 60612
- Jesse Brown VA Medical Center, Chicago, IL
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Hines, Illinois, Estados Unidos, 60141-5000
- Edward Hines Jr. VA Hospital, Hines, IL
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Minnesota
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Minneapolis, Minnesota, Estados Unidos, 55417
- Minneapolis VA Health Care System, Minneapolis, MN
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Texas
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Houston, Texas, Estados Unidos, 77030
- Michael E. DeBakey VA Medical Center, Houston, TX
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Wisconsin
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Madison, Wisconsin, Estados Unidos, 53705
- William S. Middleton Memorial Veterans Hospital, Madison, WI
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Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
21 anos e mais velhos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
Inclusion Criteria:
- Patient charts: Medical charts of Veteran patients who receive care from participating VA facility (Madison VAH, Jesse Brown VAMC, Hines VAH, Michael E. DeBakey VAMC, and Minneapolis VAMC) providers during the one year study period (tentatively October 2016-October 2017) and who have potential delays in diagnostic evaluation for lung, colorectal, liver, bladder, or breast cancer will be reviewed as part of the study.
- Providers: Providers who have seen primary care outpatients in any of the participating facilities or their outpatient clinics within the year-long study period.
Exclusion Criteria:
- Patient Charts: Medical charts of patients who are not receiving care from participating facility providers or charts of patients who do not have potential follow-up delays for lung, colorectal, liver, bladder, or breast cancer in the time period of interest.
- Providers: Providers who have not seen primary care outpatients in any of the participating facilities or their outpatient clinics within the time period of interest.
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Pesquisa de serviços de saúde
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Solteiro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Communication of Patients Lost to Follow-up to Providers
This intervention will consist of two related, continuous steps over at least a 12-month period.
In the first step, the investigators will query the VA's Corporate Data Warehouse (CDW, a repository of near real-time patient data from all VA medical centers) weekly to identify possible lost to follow-up events in a pre-specified time period and for a random sample of about half of the providers at the investigators' study sites.
These identified patient charts will be reviewed by Facility Recipients/Cancer Trackers at each site who will then communicate patients truly found to be lost to follow-up to the appropriate provider/care team.
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The investigators will query the VA's database weekly to identify possible lost to follow-up events for a random sample of about half of the providers at our study sites.
The queries will use the trigger criteria developed in our previous work for colorectal cancer, lung cancer, hepatocellular carcinoma, breast cancer, and bladder cancer.
The list of trigger positive patients will be transmitted to a facility-level recipient who will either disseminate the information to existing facility individual cancer care coordinators/trackers or will review the charts of the "triggered" patients in order to determine whether these patients have been truly lost to follow-up or not.
If patients are found to be lost to follow-up, the Facility Recipient or cancer care coordinator/tracker will communicate the need for follow-up to the PACT or primary care provider, using secure emails, phone calls, or in person, depending on which method of communication they deem most appropriate and effective.
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Sem intervenção: Usual Care
In the usual care group, providers will continue to use the existing notification system to receive abnormal test results in accordance with institutional norms, policies, and procedures.
There are no formal patient-tracking programs currently at our study sites for all abnormal test results.
The investigators will apply our computerized surveillance tools in the usual care arm only when the investigators are ready to conduct the final chart reviews on intervention patients and identify these patients in similar time periods as in the intervention arm.
If persistent delays are found, the investigators will inform the patients' primary care providers.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
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Median Time from Initial Follow-up Delay to Follow-up Action
Prazo: 1 year
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The investigators will conduct chart reviews of patients shown by our automated surveillance system to have not received appropriate follow-up care in both intervention and control groups at least 6 months after the first documentation of a diagnostic clue (e.g., initial abnormal chest X-ray).
Chart review will be used to quantify time in days from documentation of the clinical clue to the time when follow-up action on that clue was initiated.
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1 year
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Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Hardeep Singh, MD MPH BS, Michael E. DeBakey VA Medical Center, Houston, TX
Publicações e links úteis
A pessoa responsável por inserir informações sobre o estudo fornece voluntariamente essas publicações. Estes podem ser sobre qualquer coisa relacionada ao estudo.
Publicações Gerais
- Murphy DR, Meyer AN, Russo E, Sittig DF, Wei L, Singh H. The Burden of Inbox Notifications in Commercial Electronic Health Records. JAMA Intern Med. 2016 Apr;176(4):559-60. doi: 10.1001/jamainternmed.2016.0209. No abstract available.
- Bhise V, Meyer AND, Singh H, Wei L, Russo E, Al-Mutairi A, Murphy DR. Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic Health Records. Am J Med. 2017 Aug;130(8):975-981. doi: 10.1016/j.amjmed.2017.03.009. Epub 2017 Mar 31.
- Murphy DR, Meyer AN, Vaghani V, Russo E, Sittig DF, Richards KA, Wei L, Wu L, Singh H. Application of Electronic Algorithms to Improve Diagnostic Evaluation for Bladder Cancer. Appl Clin Inform. 2017 Mar 22;8(1):279-290. doi: 10.4338/ACI-2016-10-RA-0176.
- Meyer AND, Murphy DR, Al-Mutairi A, Sittig DF, Wei L, Russo E, Singh H. Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism. J Gen Intern Med. 2017 Jul;32(7):753-759. doi: 10.1007/s11606-017-3988-z. Epub 2017 Jan 30.
- Menon S, Singh H, Giardina TD, Rayburn WL, Davis BP, Russo EM, Sittig DF. Safety huddles to proactively identify and address electronic health record safety. J Am Med Inform Assoc. 2017 Mar 1;24(2):261-267. doi: 10.1093/jamia/ocw153.
- Baldwin JL, Singh H, Sittig DF, Giardina TD. Patient portals and health apps: Pitfalls, promises, and what one might learn from the other. Healthc (Amst). 2017 Sep;5(3):81-85. doi: 10.1016/j.hjdsi.2016.08.004. Epub 2016 Oct 3.
- Singh H, Graber ML, Hofer TP. Measures to Improve Diagnostic Safety in Clinical Practice. J Patient Saf. 2019 Dec;15(4):311-316. doi: 10.1097/PTS.0000000000000338.
- Singh H. Improving Diagnostic Safety in Primary Care by Unlocking Digital Data. Jt Comm J Qual Patient Saf. 2017 Jan;43(1):29-31. doi: 10.1016/j.jcjq.2016.10.007. Epub 2016 Oct 14. No abstract available.
- Giardina TD, Sarkar U, Gourley G, Modi V, Meyer AN, Singh H. Online public reactions to frequency of diagnostic errors in US outpatient care. Diagnosis (Berl). 2016 Mar;3(1):17-22. doi: 10.1515/dx-2015-0022. Epub 2016 Feb 19.
- Singh H, Schiff GD, Graber ML, Onakpoya I, Thompson MJ. The global burden of diagnostic errors in primary care. BMJ Qual Saf. 2017 Jun;26(6):484-494. doi: 10.1136/bmjqs-2016-005401. Epub 2016 Aug 16.
- Sittig DF, Wright A, Ash J, Singh H. New Unintended Adverse Consequences of Electronic Health Records. Yearb Med Inform. 2016 Nov 10;(1):7-12. doi: 10.15265/IY-2016-023.
- Pfoh ER, Engineer L, Singh H, Hall LL, Fried ED, Berger Z, Wu AW. Informing the Design of a New Pragmatic Registry to Stimulate Near Miss Reporting in Ambulatory Care. J Patient Saf. 2021 Apr 1;17(3):e121-e127. doi: 10.1097/PTS.0000000000000317.
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Real)
27 de janeiro de 2017
Conclusão Primária (Real)
27 de janeiro de 2017
Conclusão do estudo (Real)
27 de janeiro de 2017
Datas de inscrição no estudo
Enviado pela primeira vez
16 de outubro de 2012
Enviado pela primeira vez que atendeu aos critérios de CQ
18 de outubro de 2012
Primeira postagem (Estimativa)
19 de outubro de 2012
Atualizações de registro de estudo
Última Atualização Postada (Real)
26 de fevereiro de 2018
Última atualização enviada que atendeu aos critérios de controle de qualidade
22 de fevereiro de 2018
Última verificação
1 de fevereiro de 2018
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- CRE 12-033
- CIRB 15-07 (Outro identificador: VA Central IRB)
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
Não
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Não
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
produto fabricado e exportado dos EUA
Não
Essas informações foram obtidas diretamente do site clinicaltrials.gov sem nenhuma alteração. Se você tiver alguma solicitação para alterar, remover ou atualizar os detalhes do seu estudo, entre em contato com register@clinicaltrials.gov. Assim que uma alteração for implementada em clinicaltrials.gov, ela também será atualizada automaticamente em nosso site .
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