Dual Health Systems Users: Strategies to Implement Optimal Care Coordination
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 63
- 试验地点
- 2
- 主要终点
- Patient Perceived Continuity of Care From Multiple Providers- Management Continuity
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
盲法说明
For one of the outcomes (laboratory duplication) the assessor is blind to group assignment.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •Previously shared health data with a provider via their My HealtheVet or local provider patient portal
- •No scheduled VA or non-VA appointments
研究组 & 干预措施
Usual Care
Veterans randomized to usual care will not receive any training on using their patient portal(s) to access and share information. They will be contacted via phone and/or secure messaging to remind him/her to take the VA or non-VA provider packet to their appointment. At the conclusion of the study, Veterans assigned to usual care will be provided the training information on the VA health summary for their own reference.
Care Coordination
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.
干预措施: Patient Care Coordination Training (Behavioral)
结局指标
主要结局
Patient Perceived Continuity of Care From Multiple Providers- Management Continuity
时间窗: 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
时间窗: 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
时间窗: 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.
次要结局
- 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.)
- 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 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.)
- Proportion of Medication Concordance(Time frame between two medical visits occuring within the one year study period)