Assessing the Effectiveness of Concurrent Peer Review for Patients With Cardiovascular Disease and Diabetes

Study Overview
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Brief Summary
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We will assess the impact of concurrent peer review vists on blood pressure, cholesterol and diabetes control. Concurrent peer review (CPR) visits refer to special offic visits by patients to a clinician (physician, nurse practitioner, or physician assistant) other than than their primary care provider that are specifically designed to improve care for diabetes and cardiovascular disease.

Detailed Description
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This project aims to reduce racial and ethnic disparities in health care by improving cardiovascular and diabetes management among poor and minority patients. We propose to implement and evaluate an innovative, but practical intervention: CPR visits. CPR visits are designed to minimize competing demands for clinicians and reduce clinical inertia by focusing clinician and patient attention on optimizing cardiovascular and/or diabetes management and disease control and through use of clinician prompts and decision support at the point of care. Following training of clinician staff, CPR visits will be implemented within two sites of a single community health center (Westside Health Services, Inc). Patients will be randomly assigned one CPR visit with a clinician other than their primary care clinician or to usual care. The primary study outcome will include control of hypertension, diabetes, and lipids. Secondary outcomes will include process measures for cardiovascular and diabetes care. Both personnel and data collection infrastructure will build on the existing Health Disparities Collaborative at Westside. A research team from the University of Rochester will assist in the implementation of study design. This team will lead both the quantitative and qualitative evaluation of the project including outcome and process measures. Project findings offer promise for improving care to underserved populations through dissemination and implementation of a feasible strategy among practices caring for the underserved. Findings will be disseminated nationally in conjunction with the Robert Wood Johnson Foundation, the National Association of Community Health Centers, and the National Health Disparities Collaborative and through publication in the peer reviewed literature and presentation at national conferences.

Official Title
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Concurrent Peer Review Visits to Reduce Cardiovascular Risk Factors

Conditions
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Cardiovascular Diseases

Intervention / Treatment
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* Other: Usual Care
* Behavioral: Concurrent Peer Review visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Active patient at Westside Health Services. Currently enrolled in the Health Disparities Collaborative at WHS. At least one visit to primary care provider in past year. Any of the following documented during the preceding three months: BP not at goal e,g. (BP 140/80 or greater unless has DM, CAD or CRI then BP greater than 130/80), LDL-C not at goal (level dependent on absolute ATP III CVD risk) or glycated hemoglogin 7 percent or higher Exclusion Criteria: Less than 18 years of age

Ages Eligible for Study
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Minimum Age: 18 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: Health Services Research
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control<br>usual care | Other: Usual Care<br>* Usual Care with primary care provider during time period<br>|
| Experimental: Concurrent Peer Review Visit<br>See description of interventioin | Behavioral: Concurrent Peer Review visit<br>* Participants are offered an office visit with a peer of their clinician primary clinician. This office visit is structured and focused on blood pressure, diabetic, and/or lipid control with decision support available at point of care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean change in blood pressure, glycated hemoglobin, and LDL-cholesterol between baseline and follow-up |  | 7 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of aspirin, ACE inhibiters/ARBs (diabetic patients), pneumonia vaccine updated, diabetic foot exam, diabetic microalbumuria check, retinal exam, smoking cessation counseling, dental visit, and self management goal |  | one year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiovascular disease, Diabetes, Quality improvement, Peer review