Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial

Study Overview
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Brief Summary
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The investigators' study focuses on improving the care of diabetes, a complex chronic illness, by providing important insights into interprofessional training and its potential role in fostering the necessary interdisciplinary management needed for chronic conditions and in addressing the gap between best practice and actual care provided.

Detailed Description
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The complexity of diabetes management challenges the acute care-oriented healthcare system. Some experts suggest part of the problem is that the healthcare system fosters a separate silos decision making model. While there is increasing recognition that quality diabetes care is best provided in an interdisciplinary manner, interprofessional training models are limited, as is understanding of the links between interprofessional training, actual practice, and patient outcomes. Advancing our understanding of interprofessional training models is critical because most of the complications associated with diabetes (e.g., amputations, renal failure, strokes) can be prevented or delayed with proper management. The investigators' objective is to better understand the processes and mechanisms by which interprofessional training impacts on chronic care management (practice patterns) and the ways it translates into improved patient outcomes.

Official Title
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Interprofessional Training for Improving Diabetes Care

Conditions
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Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: CLINICIANS All clinicians in all of Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study (all PCPs have patients with DM in their panel of patients). PATIENTS All diabetic patients who are seen in Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study. Exclusion Criteria: CLINICIANS Any clinician who does not have diabetic patients on their panel, who aren't apart of Ohio's CBOC's, or see patients at the Georgetown CBOC will not be eligible to participate. PATIENTS Patients who don't have a diagnosis of diabetes, who aren't seen at one of Ohio's CBOC's, or is seen for their medical care at the Georgetown CBOC will not be eligible to participate.

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation. | |
| Experimental: ReSPECT Intervention<br>Intervention sites will receive baseline measures pre and post, but also in-depth Shared Medical Appointments (SMA)(The Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT) intervention) and at 15 months SMA video conferences. At the end of the 18 months the randomly selected patients and providers will be asked to take part in a qualitative interview. | Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)<br>* The intervention is designed to educate the clinicians at intervention CBOCs by modeling interprofessional team practices during SMAs for diabetes mellitus (DM) patients from each CBOC primary care provider's (PCP) patient panel. We hypothesize that this education at intervention CBOCs will improve interprofessional practices and overall quality care delivered to veterans.<br>* Other names: ReSPECT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network | Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities: Instruct patients on home glucose monitoring Teach foot care Teach insulin administration Instruct patients about diet Help patients make changes in their diets that you have recommended Instruct patients about regular exercise Help patients make changes in their exercise habits that you have recommended Identify candidates for long-acting insulin Interpret glucose patterns Adjust insulin in insulin-treated patients with poor glycemic control Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin Manage patients with poor glycemic control Initiate insulin therapy (NPH or insulin glargine and aspart) Apply principles of diabetes care in a team setting Averages of provider efficacy were calculated across all activities. | Baseline | 
| Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network | Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities: Instruct patients on home glucose monitoring Teach foot care Teach insulin administration Instruct patients about diet Help patients make changes in their diets that you have recommended Instruct patients about regular exercise Help patients make changes in their exercise habits that you have recommended Identify candidates for long-acting insulin Interpret glucose patterns Adjust insulin in insulin-treated patients with poor glycemic control Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin Manage patients with poor glycemic control Initiate insulin therapy (NPH or insulin glargine and aspart) Apply principles of diabetes care in a team setting Averages of provider efficacy were calculated across all activities. | 22 months (post-intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attitudes Toward Healthcare Teams Scale and Subscales | A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams. | Baseline | 
| Attitudes Toward Healthcare Teams Scale and Subscales | A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams. | 22 months (post-intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Telemedicine, Shared Medical Appointments