Comprehensive Informatics Framework for Comparative Effectiveness Research (CER) Dissemination

Study Overview
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Brief Summary
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In this project the investigators seek to utilize our experience for developing a comprehensive informatics framework for rapid adaptation and dissemination of Comparative Effectiveness Research (CER) products tailored to different categories of health consumers including difficult-to-reach patients. Based on our previous successful experience in computer-assisted education, the investigators will refine the current CO-ED platform to implement and test a novel system for individualized continuous patient education (iCOPE). The iCOPE platform will be specifically designed to support rapid adaptation, customization, and dissemination of the CER products to the difficult-to-reach populations. The iCOPE platform will implement universal means for customized delivery of CER information in the format of interactive self-paced educational modules, quick question & answer guides, and interactive decision aids. In addition, the iCOPE platform will support the innovative concept of continuous patient health education by providing patients with easy access to the interactive CER updates via web, MP3 players and phone-based interactive voice response (IVR) technology. Though iCOPE will be designed to support the whole spectrum of CER products, in this project the investigators will focus on the Comparative Effectiveness Research Summary Guide (CERSG) entitled Pills for Type 2 Diabetes. The following primary hypothesis will be tested in the RCT: Use of the iCOPE platform will be associated with improvement in CERSG knowledge in elderly at 6 months after the intervention. The investigators will also examine the impact of iCOPE on medication adherence self-efficacy, diabetes medication satisfaction, HbA1c, and CERSG acceptance.

Detailed Description
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Interactive, computer-based education has the potential to greatly increase interest, because the learner actively participates in the learning process (Fox, 2009). In addition, the involvement of auditory, visual, and interactive learning strategies can increase recall of information. Computer-assisted educational programs may incorporate features that promote ease of use, be written in multiple languages, be scripted at a level that addresses the needs of low literacy learners, and be viewed as often as needed by a patient (Fox, 2009). Several studies reported results of using computer technology in educating elderly patients about health conditions. Stromberg et al (2006) used a single-session, interactive computer-based educational program about chronic heart failure in elderly patients. They demonstrated that interactive computer-mediated education may be effectively used to increase patients' knowledge, about heart failure. Another study, conducted by Lin et al (2009), evaluated the usability of a touch-screen-enabled personal education program (PEP). The results showed that the system was evaluated as usable and useful, and older adults were satisfied with their experience. Similar findings were reported by Neafsey et al (2008) who also evaluated a patient-centered computer-mediated program using touch screen computers. Authors reported high satisfaction of the older adult users, increased knowledge and self-efficacy for avoiding adverse self-medication behaviors. Elderly patients are less likely than younger patients to seek incidental information on their condition via internet. (Tian & Robinson, 2008) Elderly patients therefore are less likely to navigate internet looking for information about evidence or treatment guidelines for their conditions. More targeted efforts may be needed to reach such populations. Disseminating information via combination of high technology media along with traditional media that are easily usable is helpful (Longo, 2005). A recent review of barriers and drivers of health IT use by elderly, very ill, and underserved, revealed that such technology can play a role in offering effective interventions. The consumer perceptions on benefits from use of system, convenience of use, and familiar technology were all important factors for intervention success (Jimison et al., 2008).

Official Title
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Comprehensive Informatics Framework for Comparative Effectiveness Research (CER) Dissemination

Conditions
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Type 2 Diabetes

Intervention / Treatment
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* Other: iCOPE Intervention group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: have clinical diagnosis of Type 2 diabetes; take oral diabetes medications; be 65 years of age or older at the time of randomization; plan to remain in the Maryland/DC area until the completion of the study follow-up; understand English at the 5th grade level. Exclusion Criteria: plan to leave Maryland/DC area before the completion of the study follow- up; presence of significant cognitive impairment based on a Mini-Mental State Examination (MMSE) score ≤23 do not speak English.

Ages Eligible for Study
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Minimum Age: 65 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: Supportive Care
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group<br>The study participants randomized to the Group 2 will serve as a control. At the beginning of the study, they will receive a CERSG brochure printed from the AHRQ site. They will be asked to study it to the best of their ability throughout the day. | |
| Experimental: iCOPE Intervention group<br>iCOPE intervention group will receive a CERSG brochure via the iCOPE system. | Other: iCOPE Intervention group<br>* The study participants in the intervention group will use iCOPE platform providing adapted CERSG content in an interactive and tailored way. The intervention provided by the iCOPE platform will be implemented with the understanding that it should be user-friendly and not time consuming. Initially, all participants will be asked to complete the computer-mediated interactive CERSG module via touch screen tablet PC provided at hospital, in a primary care office, and in senior centers. The total time to complete the curriculum is about 30 min, however the patients will be able to distribute this time throughout a day at their convenience. Once the educational curriculum is completed, the intervention subjects will receive access to other components of the iCOPE platform.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in CERSG Knowledge Score from baseline to 24-hr and to 6-month follow up | CERSG Knowledge Score will be used to assess the overall patient knowledge of the information provided in the CERSG entitled Pills for Type 2 Diabetes. The score will represent a percentage of correct answers to 30 true/false items designed in accordance with the content of the CERSG. | The Knowledge Test will be administered at the baseline, 24-hr after the introduction of the CERSG, and at the 6-month follow-up. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medication adherence self-efficacy | Medication adherence self-efficacy will measure self-efficacy of taking medications. | The medication adherence self-efficacy measure will be administered at the baseline, 24-hr after the introduction of the CERSG, and at the 6-month follow-up. | 
| Diabetes Medication Satisfaction | Diabetes Medication Satisfaction measure is a diabetes-specific measure, assessing medication treatment satisfaction in three domains: Efficacy, Burden, Symptoms (Side Effects). | Diabetes medication satisfaction measure will be administered at the baseline and at the 6-month follow-up. | 
| Glucosylated hemoglobin (HbA1c) | Glucosylated hemoglobin (HbA1c) will be obtained from Electronic Medical Record (Centricity) at Johns Hopkins Community Physicians (JHCP). | Glucosylated hemoglobin (HbA1c) values will be obtained closest to the date of the baseline evaluation and 6-month follow-up. | 
| CERSG Acceptance | CERSG acceptance will measure patient acceptance and comprehension of CERSG | The CERSG acceptance measure will be administered at the baseline, 24-hr after the introduction of the CERSG, and at the 6-month follow-up. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes, Comparative Effectiveness Research, Interactive computer-assisted education, Informatics