Program for Research on the Outcomes of VA Education (PROVE)
1 мая 2018 г. обновлено: 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.
Обзор исследования
Статус
Завершенный
Условия
Вмешательство/лечение
Подробное описание
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.
Тип исследования
Интервенционный
Регистрация (Действительный)
5000
Фаза
- Непригодный
Контакты и местонахождение
В этом разделе приведены контактные данные лиц, проводящих исследование, и информация о том, где проводится это исследование.
Места учебы
-
-
New York
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Brooklyn, New York, Соединенные Штаты, 11209
- VA NYHHS Brooklyn Campus
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New York, New York, Соединенные Штаты, 10010
- VA NYHHS Manhattan Campus
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-
Критерии участия
Исследователи ищут людей, которые соответствуют определенному описанию, называемому критериям приемлемости. Некоторыми примерами этих критериев являются общее состояние здоровья человека или предшествующее лечение.
Критерии приемлемости
Возраст, подходящий для обучения
- Ребенок
- Взрослый
- Пожилой взрослый
Принимает здоровых добровольцев
Да
Полы, имеющие право на обучение
Все
Описание
Inclusion Criteria:
- non-specialized primary care clinical microsystems
Exclusion Criteria:
- specialized clinical microsystems
- pilot clinical patient-aligned care teams
Учебный план
В этом разделе представлена подробная информация о плане исследования, в том числе о том, как планируется исследование и что оно измеряет.
Как устроено исследование?
Детали дизайна
- Основная цель: Исследования в области здравоохранения
- Распределение: Рандомизированный
- Интервенционная модель: Параллельное назначение
- Маскировка: Нет (открытая этикетка)
Оружие и интервенции
Группа участников / Армия |
Вмешательство/лечение |
|---|---|
|
Активный компаратор: PM-Data
Team will receive data only.
|
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.
|
|
Экспериментальный: PM-Support
Team will receive data and panel management support
|
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.
Другие имена:
|
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Экспериментальный: 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.
Другие имена:
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.
Другие имена:
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Что измеряет исследование?
Первичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
|
Change in Smoking Status
Временное ограничение: Baseline and 12 months
|
clinical outcome
|
Baseline and 12 months
|
|
Change in Blood Pressure Reading
Временное ограничение: Baseline and 12 months
|
clinical outcome
|
Baseline and 12 months
|
Вторичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
|
Change in weight
Временное ограничение: Baseline and most recent at 12 months
|
Baseline and most recent at 12 months
|
|
|
Change in Patient Activation
Временное ограничение: 6 months and 12 months
|
The Patient Activation Measure (PAM) is used to assess patients' self-reported knowledge, skill, and confidence in self-managing of health and chronic conditions
|
6 months and 12 months
|
|
Change in Patient Perceptions of Quality of Care
Временное ограничение: 6 months and 12 months
|
6 months and 12 months
|
|
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Change in Provider Behavior change expertise
Временное ограничение: 6 months and 12 months
|
6 months and 12 months
|
|
|
Change in Provider Self-efficacy with Panel Management Tasks
Временное ограничение: Baseline and 12 months
|
Baseline and 12 months
|
|
|
Change in Provider Job Satisfaction
Временное ограничение: Baseline and 12 months
|
Baseline and 12 months
|
|
|
Change in Microsystem function and collective efficacy
Временное ограничение: Baseline and 12 months
|
Baseline and 12 months
|
|
|
Change in Provider's assessments of training that they received in panel management and working within a PACT team
Временное ограничение: 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
Временное ограничение: Baseline and 12 months
|
Baseline and 12 months
|
|
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Change in Proportion of smokers on the panel received any cessation medications
Временное ограничение: Baseline and 12 months
|
This information will be culled from the Vista Smoking Database
|
Baseline and 12 months
|
Другие показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
|
Change in Health care usage
Временное ограничение: Baseline and 12 months
|
Number of primary care visits, mental health visits, emergency room/urgent care visits and the number of VA hospitalizations
|
Baseline and 12 months
|
|
Change in Patient-level costs
Временное ограничение: Baseline and 12 months
|
Outpatient primary care visits, mental health visits, pharmacy and hospitalizations from the VA Decision Support System
|
Baseline and 12 months
|
Соавторы и исследователи
Здесь вы найдете людей и организации, участвующие в этом исследовании.
Следователи
- Главный следователь: Mark D Schwartz, VA New York Harbor Healthcare System
- Главный следователь: Scott Sherman, M.D., M.P.H., VA New York Harbor Healthcare System
- Директор по исследованиям: Colleen Gillespie, PhD, NYU Langone Health
- Директор по исследованиям: Anne Dembitzer, M.D., VA New York Harbor Healthcare System
Публикации и полезные ссылки
Лицо, ответственное за внесение сведений об исследовании, добровольно предоставляет эти публикации. Это может быть что угодно, связанное с исследованием.
Даты записи исследования
Эти даты отслеживают ход отправки отчетов об исследованиях и сводных результатов на сайт ClinicalTrials.gov. Записи исследований и сообщаемые результаты проверяются Национальной медицинской библиотекой (NLM), чтобы убедиться, что они соответствуют определенным стандартам контроля качества, прежде чем публиковать их на общедоступном веб-сайте.
Изучение основных дат
Начало исследования (Действительный)
1 сентября 2009 г.
Первичное завершение (Действительный)
31 августа 2014 г.
Завершение исследования (Действительный)
31 августа 2015 г.
Даты регистрации исследования
Первый отправленный
28 августа 2012 г.
Впервые представлено, что соответствует критериям контроля качества
29 августа 2012 г.
Первый опубликованный (Оценивать)
3 сентября 2012 г.
Обновления учебных записей
Последнее опубликованное обновление (Действительный)
7 мая 2018 г.
Последнее отправленное обновление, отвечающее критериям контроля качества
1 мая 2018 г.
Последняя проверка
1 мая 2018 г.
Дополнительная информация
Термины, связанные с этим исследованием
Ключевые слова
Дополнительные соответствующие термины MeSH
Другие идентификационные номера исследования
- EDU 08-428-2
Эта информация была получена непосредственно с веб-сайта clinicaltrials.gov без каких-либо изменений. Если у вас есть запросы на изменение, удаление или обновление сведений об исследовании, обращайтесь по адресу register@clinicaltrials.gov. Как только изменение будет реализовано на clinicaltrials.gov, оно будет автоматически обновлено и на нашем веб-сайте. .