Pilot Study to Improve Care Coordination

Not Applicable

Completed

• Conditions: Chronic Illness
• Interventions: Behavioral: Patient Care Coordination Training

• Registration Number: NCT02386189
• Lead Sponsor: VA Office of Research and Development

Brief Summary

The purpose of this study is 1) to learn how VA patients can help share their health information between their VA providers and providers outside the VA and 2) if sharing this information is useful to providers and improves care received.

Detailed Description

Recent studies estimate that 43 to 75% of Veterans also receive care from non-VA providers (dual use). Dual use is a concern because splitting care between two or more health systems and multiple providers may result in poor coordination of services and a loss of continuity -ultimately putting the patient at increased risk for poor outcomes. Addressing dual use in Veterans is an issue of care coordination. One component of care coordination is information sharing, which often relies on the patient to share information between systems/providers. Veterans registered in My HealtheVet with premium account status have access to download and print a VA health summary (VA CCD). This health summary can be shared with non-VA providers to inform them about recent VA care. This pilot randomized controlled trial will compare usual care to an intervention which aims to improve care coordination for dual use Veterans by educating them about the use of information technology to share health information and informing their providers about the extent and nature of care from other health care systems.

Methods: Dual use Veterans with at least one chronic health condition and both an upcoming VA and non-VA appointments within the study time frame will be eligible to participate. Veterans will be randomized to the intervention or usual care. Veterans in the intervention group will be trained on use of My HealtheVet and their community patient portal (if applicable) to access summary health information to share with providers. In addition, he/she will create a document that lists all members of their health care team. All participants will be asked to take a provider evaluation packet each provider visit (VA and non-VA). After the visit, a phone call will be scheduled with the Veteran to ask about the appointment and medical records from the appointment will be obtained. Outcomes: The main outcomes will be related to patient perceived continuity of care, provider relational coordination survey, medication concordance, and medical laboratory test duplication. Pre and post scores on the patient activation measures will also be explored.

Study Timeline

• Study First Submitted: 2015-02-11
• Study Start: 2015-03-02
• Study First Submitted QC: 2015-03-05
• Study First Posted: 2015-03-11
• Primary Completion: 2017-03-01
• Study Completion: 2017-03-31
• Results First Submitted: 2018-03-21
• Results First Submitted QC: 2019-05-24
• Results First Posted: 2019-07-30
• Status Verified: 2019-08
• Last Update Submitted: 2019-08-19
• Last Update Posted: 2019-08-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 63

Inclusion Criteria

VA Patient

• Receives health care from VA and non-VA provider
• Diagnosed with a chronic health condition
• Prescribed 5 or more medications
• Upcoming VA and non-VA appointments within the study time frame
• Registered or willing to become registered with My HealtheVet
• Access to a computer with internet, phone, and a printer.
• English speaking

VA or Non-VA Providers: provide care to a stuy participant

Read More

Exclusion Criteria

• Previously shared health data with a provider via their My HealtheVet or local provider patient portal
• No scheduled VA or non-VA appointments

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Care Coordination	Patient Care Coordination Training	Veterans in this group will share a comprehensive list of all of their providers (VA and non-VA) at future appointments. He/she will also be trained on how to create a VA Health Summary in My HealtheVet to share with their non-VA providers and how to use their community portals (if available) to share information back to VA providers. A VA and non-VA provider visit will be evaluated.

Primary Outcome Measures

Name	Time	Method
Patient Perceived Continuity of Care From Multiple Providers- Management Continuity	The time frame is from baseline assessment to 12 months post baseline during which at least one VA and one Community medical visit occurred.	Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Management continuity refers to the patient being able to identify one provider who is the main coordinator and assures all the links within the health care team. The possible range on this measure was between 5 and 40 and the analysis was conducted on the pre-post difference on Management Continuity, subtracting the baseline score from the post-intervention score. More positive score indicated greater perceived management continuity and greater improvement in perceived management continuity.
Patient Perceived Continuity of Care From Multiple Clinicians - Informational Continuity	Baseline to 12-month follow-up	Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Informational Continuity refers to whether patients experienced communication failures between providers. The possible range on this measure was between 12 and 36. The analysis was conducted on the pre-post difference on Informational Continuity, subtracting the baseline score from the post-intervention score. For this measure a lower score and a decline between post intervention and baseline scores (or a negative value) indicates more positive outcomes.
Patient Perceived Continuity of Care From Multiple Clinicians- Role Continuity	Baseline to 12-month follow-up	Patient Perceived Continuity of Care was assessed using Haggerty's measure of the same title. Role Continuity refers to the role of all clinicians being clear to the patient and to the providers on the treatment team. The possible range on this measure was between 6 and 30, and the analysis was conducted on the pre-post difference on this measure. More positive score indicated greater perceived role clarity and, when comparing pre and post score, a more positive score indicated greater improvement in perceived role clarity.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Duplication of Laboratory Tests	Baseline assessment to 12 months post-baseline, where a laboratory duplication is only counted if the medical visits occurred within three months of each other.	Participants had at least one VA medical visit and one community medical visit. Medical records were obtained from both visits and compared. Patients were considered to have a laboratory duplication if the same labs were drawn at both visits and the two visits occurred within three months of each other.
Relational Coordination- VA Providers	Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.	Relational Coordination was assessed using Gittell's 7-item measure as described Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. This was assessed by providers seeing patients enrolled in this study, and this outcome is based on VA providers assessment of Relational Coordination. The scale total score could range from 7 to 35 with higher scores indicating greater relational coordination.
Relational Coordination Community Providers	Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.	Relational Coordination was assessed using Gittell's 7-item measure as described iRelational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. The scale total score could range from 7 to 35 with higher scores indicating greater relational coordination.
Proportion of Medication Concordance	Time frame between two medical visits occuring within the one year study period	All participants had at least one VA medical visit and one community medical visit. Medical records were obtained from both visits. Medication lists were obtained from both visits. A medication concordance metric (proportion) was calculated where the denominator was the total number of unique medications identified on both the VA medication list and the community provider medication list. The numerator was the total number of medications (including dose and frequency) that were concordant between the medication lists. This comparison did not include over the counter medications.

Trial Locations

Locations (1)

Iowa City VA Health Care System, Iowa City, IA; 🇺🇸 Iowa City, Iowa, United States