Expanding Technology-Enabled Nurse Delivered Chronic Disease Care
- Conditions
- Diabetes Mellitus, Type 2Hypertension
- Interventions
- Behavioral: EXTEND PlusBehavioral: EXTEND
- Registration Number
- NCT05120544
- Lead Sponsor
- Duke University
- Brief Summary
The purpose of this study is to investigate whether the self-management of diabetes and hypertension can be improved with the use of mobile monitoring devices and nursing support.
- Detailed Description
EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) seeks to address evidence gaps that prevent practical use of mobile monitoring-enabled telehealth for clinic-refractory chronic diseases, with an initial focus on Persistent Poorly Controlled Diabetes Mellitus (PPDM) and hypertension. Because our population has already proven refractory to usual care, we will conduct an active comparator randomized trial (N=220) of two 12-month interventions: 1) mobile monitoring as a self-management tool (EXTEND); and 2) a nurse-delivered intervention incorporating mobile monitoring, self-management support, and medication management (EXTEND Plus). The medication management is a care team approach where the nurse works with a Pharmacist who has prescribing rights to optimize medications for the patients. This proposal will also allow us to examine a novel application for mobile monitoring technologies, as tools for predicting patient safety events.
Aim 1: Compare the effectiveness of the two 12-month EXTEND interventions for PPDM and hypertension. Hypothesis 1a: Compared to EXTEND, EXTEND Plus will improve primary (HbA1c) and secondary outcomes (e.g., blood pressure, weight, self-management measures) at 12 months; Hypothesis 1b: The relative effects of each intervention will be sustained at 24 months; Hypothesis 1c: Subgroup analyses will identify characteristics associated with high responsiveness to each intervention.
Aim 2: Guide scaling and dissemination of the EXTEND interventions by: (A) interviewing patients and stakeholders to clarify implementation barriers, facilitators and process requirements; (B) comparing intervention costs against potential reimbursement mechanisms; and (C) understanding the role of climate change and other social drivers of health on diabetes self-management and intervention engagement.
Aim 3: Explore the value of combining mobile monitoring and EHR data for predicting patient safety events (hospitalizations, emergency visits) in the EXTEND study cohort over 24 months. Participants will monitor their data using a suite of remote monitoring devices. Data will be analyzed with PACE by our team. If participants are randomized to the telehealth arm, these data will be reviewed by a RN during a telehealth visit to aid in clinical decision making.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 220
- type 2 diabetes by International Classification of Diseases (ICD) code or treatment with glucose-lowering medication or mention in clinical notes
- Poor diabetes control as indicated by at least 1 HbA1c greater than or equal to 8.0% with NO HbA1c less than 8.0% over the past 6 months
- At least 1 appointment (office visit, appointment, initial consult, telemedicine) at primary clinic site over the past year
- hypertension by ICD code or treatment with blood pressure-lowering medication or mention in clinical notes
- poor hypertension control as indicated by a clinic systolic BP >140 AND/OR diastolic BP >90 over past year
- use of an Apple iPhone or Android smartphone
- can provide informed consent
- can read/speak English
- can provide informed consent
- dementia, psychosis, or life-limiting illness
- acute coronary event in past year
- hypoglycemic seizure/coma over the past year
- residence in a nursing home
- use of an insulin pump
- are or plan to become pregnant
- unable or unwilling to use necessary technology to participate in study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description EXTEND Plus EXTEND Plus EXTEND Plus participants receive 4 mobile monitoring devices to facilitate chronic disease self-management (glucometer, BP cuff, scale, accelerometer). Device data are transferred to Duke University Health System (DUHS) for use as part of nurse-delivered intervention combining mobile monitoring, self-management support, and medication management. The intervention is administered by clinical registered nurses (RNs) from Duke Primary Care (DPC) or Duke Endocrinology. For the medication management component, RNs work with a study PharmD affiliated with the participant's clinic. The PharmD determines if medication changes are needed, and prescribes accordingly. The RNs deliver EXTEND Plus via scheduled telephone encounters throughout the 12-month intervention. The initial encounter frequency is every two weeks, but may be extended to every four weeks for patients achieving treatment goals. EXTEND EXTEND EXTEND participants receive 4 mobile monitoring devices to facilitate chronic disease self-management (glucometer, BP cuff, scale, accelerometer). Device data are transferred to Duke University Health System (DUHS). Participants can review data and trends within the device apps and modify self-management practices accordingly. The EXTEND group continues chronic disease care with their existing providers during the study, and are instructed at baseline to address management questions via their primary clinics' established avenues (as would be the case for any patient using mobile monitoring in clinical practice).
- Primary Outcome Measures
Name Time Method Change in HbA1c Baseline, 3, 6, 9, 12, 18 and 24 months Change in blood sugar (glucose) attached to hemoglobin. Validated point-of-care or lab-based test.
- Secondary Outcome Measures
Name Time Method Change in medication non-adherence Baseline, 6, 12, 18 and 24 months Validated self-report measure using Voils' medication non-adherence measure.
Change in weight Baseline, 3, 6, 9, 12, 18 and 24 months Measurement taken with lab scale, when patient is lightly clothed, shoes off.
Change in Perceived Competence Scale Baseline, 6, 12, 18 and 24 months Measure of diabetes self-efficacy and capacity. Perceived Competence Scale (PCS): 4 items, Scale 1-7. Scoring: average (1-7) Higher score indicates greater self-efficacy.
Change is Diabetes Distress Scale Baseline, 6, 12, 18 and 24 months Measure of diabetes distress and burden using the Diabetes Distress Scale (DDS): 17 items, Scale 1-6. Scoring: Average. Higher score indicates higher distress level.
Change in Diabetes Self-Management Questionnaire Baseline, 6, 12, 18 and 24 months Measure of diabetes self-care. Diabetes Self-Management Questionnaire (DSMQ): 16 items, Scale 0-3. Scoring: Sum and transform to fall between 0-10. Higher score indicates more effective self-care.
Change in diabetes knowledge Baseline, 6, 12, 18 and 24 months Diabetes Knowledge Questionnaire (DKQ) is a 24-item validated measure.
Change in blood pressure Baseline, 3, 6, 9, 12, 18 and 24 months Measure taken at clinic with standard arm cuff. Measurement is the average of two readings, on the same arm, taken 10 minutes apart.
Change in hypertension knowledge Baseline, 6, 12, 18 and 24 months Hypertension Knowledge Measure (HKM) is an 11-item validated measure.
Trial Locations
- Locations (1)
Duke University Medical Center
🇺🇸Durham, North Carolina, United States