Intervention to Increase Screening for Glucocorticoid Induced Diabetes
Condition: Diabetes Mellitus
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      Using glucocorticoid induced diabetes (GID) we will conduct a small feasibility randomized
      intervention trial to improve GID management for veterans who are prescribed chronic
      glucocorticoids. Approximately 20 primary care providers (caring for approximately 100
      veterans on chronic steroids) will receive decisional support (automatically-derived orders
      for hemoglobin A1C, to be co-signed by providers). Approximately 20 providers (caring for 100
      veterans) who did not receive decisional support will serve as the control population. We
      will measure the time from randomization until the provider signs an order for hemoglobin A1C
      for both groups. The trial will be conducted at the VA's Eastern Colorado Health Care System
      (ECHCS) and will last approximately 6 months. After the completion of the trial for each
      provider, we will conduct a brief interview and survey of the participating providers to
      assess the acceptability of decisional support interventions to manage GID [protocol, page
      1-2]. No patient data (PHI) will be collected by the providers.
    

Detailed description: 
      Aim 1: Conduct a single site randomized controlled feasibility trial of a decisional support
      intervention to reduce ADRLLS by improving providers' adherence to GID prevention measures.
      Approximately 20 primary care providers (caring for approximately 100 veterans on chronic
      steroids who have not been screened for diabetes in the last year) will be randomly assigned
      to receive decisional support for GID prevention measures (automatically-derived orders for
      hemoglobin A1C, to be co-signed by providers). These providers will be compared with 20
      providers (caring for 100 veterans not screened for diabetes in the last year) who are
      randomly assigned to not receive decisional support for management of GID (i.e. the control
      group). The trial will be conducted at the VA's Eastern Colorado Health Care System (ECHCS)
      and will last approximately 6 months. Study administration will be coordinated through the
      Colorado Research Award Enhancement Program (Colorado REAP).

      Aim 1a) Procedural Endpoints: As a feasibility trial, this study includes multiple procedural
      endpoints, such as provider participation rates, to assess the viability of the intervention,
      rather than a single primary efficacy outcome measure (for details, pages 6-7).

      Aim 1b) Preliminary Estimates of Efficacy: We will determine the Delay Interval-the number of
      days from when a provider is randomized until the provider orders the GID prevention measure.
      Use of this continuous measure will maximize the power of this feasibility study, though we
      will also determine proportions of patients for whom these measures were ordered at six
      months, so that we may estimate the sample size for a subsequent multi-center randomized
      control trial.

      Aim 1c) Post-trial de-briefing: Using structured interviews, we will examine the opinions of
      providers after they have participated in the GID feasibility trial, in order to gather
      additional qualitative data regarding the ADRLL framework and refine the intervention for a
      subsequent randomized controlled trial. Providers will also complete a brief survey assessing
      their preference for the intervention.
    

Intervention name(s): Decision support; Usual Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Clinical pharmacists mediated computerized decision support; clinicians typical apporach for GID monitering
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: efficacy; glucocorticoid