Health Coach Program to Improve Chronic Disease Outcomes Following an Emergency Department Visit

Not Applicable

Completed

• Conditions: Diabetes Mellitus; Hypertension
• Interventions: Behavioral: Health Coaching

• Registration Number: NCT02386540
• Lead Sponsor: Alameda County Medical Center

Brief Summary

The purpose of this study is to determine whether health coaching initiated in the emergency department (ED) reduces subsequent ED visits, increases primary care visits, and positively impacts health outcomes in patients with diabetes and/or hypertension.

Detailed Description

Patients will be recruited by health coaches from the Highland Hospital Emergency Department. Eligible patients who agree to participate will be randomized to the control and experimental groups in a 2:1 ratio respectively because experimental group size is limited by health coach availability and greater loss-to-follow up is expected among the control group. Repeated measures analysis will be used to compare each outcome over the study period. In addition, subgroup analyses will be performed in order to stratify by baseline survey measures or amount of ED visits in the pre-observation period.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2015-02-06
• Study First Submitted: 2015-02-14
• Study First Submitted QC: 2015-03-06
• Study First Posted: 2015-03-12
• Status Verified: 2018-12
• Primary Completion: 2018-12-10
• Study Completion: 2018-12-10
• Last Update Submitted: 2018-12-14
• Last Update Posted: 2018-12-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 295

Inclusion Criteria

• Willing to work with a health coach
• Plans to reside in Alameda County for the next year
• Has a reliable phone number
• Speaks English or Spanish
• 18 years of age or older
• Meets at least one of the following three criteria: (1) Low medication adherence defined as a continuous medication gap of at least 1 month in the past year OR a new diagnosis of diabetes and/or hypertension; (2) No patient-identified primary care provider (PCP) or no visit to PCP in 1 year; (3) One or more visits to the ED in the last 6 months.

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Exclusion Criteria

• Life-expectancy less than 1 year
• Poorly controlled psychiatric illness
• Homeless
• Active and frequent use of illicit substances
• Currently incarcerated
• Already enrolled in a program for patients with high rates of hospitalization and/or emergency department visits
• Unable to consent due to an unstable condition or serious emotional or neurologic condition
• Admitted or anticipated to be admitted to the hospital from the ED

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Health Coaching	Health Coaching	Patients randomized to the experimental arm receive six months of post-ED health coaching from the Alameda County Health Coach Program (ACHCP) in addition to usual care in the emergency department at enrollment.

Primary Outcome Measures

Name	Time	Method
Number of emergency department visits	6 month period after enrollment	Self-reported measure collected via follow-up phone surveys at 1, 3, and 6 months.

Secondary Outcome Measures

Name	Time	Method
Number of primary care visits	6 month period after enrollment	Self-reported measure collected by follow-up phone surveys at 1,3, and 6 months.
Physical health and mental health (Validated measure - SF-12v2)	Baseline, 1 month, 3 months, and 6 months after enrollment	Validated measure (SF-12v2) collected at baseline and follow-up phone surveys.
Medication adherence (Validated measure - Morisky Medication Adherence Scale, MMAS-8)	Baseline, 1 month, 3 months, and 6 months after enrollment	Validated measure (Morisky Medication Adherence Scale, MMAS-8) collected at baseline and follow-up phone surveys.
Patient activation (Validated measure - Patient Activation Measure, PAM)	Baseline, 1 month, 3 months, and 6 months after enrollment	Validated measure (Patient Activation Measure, PAM) collected at baseline and follow-up phone surveys.
Type and frequency of health coach contact	6 months after enrollment	Health coach documentation notes will be analyzed to determine the average percent of each type of contact (text, phone, or in-person) and frequency of contact.
Percent of action plan goals achieved (Health coach documentation notes)	6 months after enrollment	Health coach documentation notes will be analyzed to determine the percent of goals achieved during the intervention.
Qualitative analysis of action plans (Health coach documentation notes will be analyzed, data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan)	6 months after enrollment	Health coach documentation notes will be analyzed using a grounded theory approach, where transcribed data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan.

Trial Locations

Locations (1)

Highland Hospital - Alameda Health System; 🇺🇸 Oakland, California, United States