Telehealth-delivered Peer Support to Improve Quality of Life Among Veterans With Multimorbidity

Study Overview
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Brief Summary
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The VetASSIST study is a randomized clinical trial testing whether receiving virtual health coaching from Veteran peers improves the physical and mental health-related quality of life of Veterans with multiple chronic health conditions and complex healthcare needs. VetASSIST will test the efficacy of an intervention that matches Veteran patients with multimorbidty with Veteran health coaches who will provide education, resources, guidance and support to help them manage their physical and mental health over the course of a year.

Detailed Description
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The study objective is to evaluate the effectiveness of a virtual, Veteran peer-led self-management support program (VetASSIST) to improve health related quality of life (HRQoL) for Veterans with multimorbidity compared to usual care. The investigators will conduct a type 1 hybrid effectiveness-implementation randomized controlled trial of the intervention among VA Puget Sound patients with multimorbidity. Trained peer health coaches will virtually meet one-on-one with patients to assist in daily self-management by providing information; identifying patients' values and preferences; helping them set goals in alignment with their values and preferences and problem-solve barriers to those goals; modeling skills for effective management; providing social support; linking them to clinical care and community resources; and addressing self-management barriers. Veterans with multimorbidity will be randomized to receive the peer health coaching intervention or usual care. Outcomes will be assessed remotely at baseline and 12 months. Specific aims are: 1) Test the effect of VetASSIST, compared to usual care, on the primary outcome of baseline to 12-month change in physical HRQoL, and secondary outcomes of mental HRQoL and health care utilization; 2a) Describe differences between VetASSIST and usual care on baseline to 12-month changes in intermediate outcomes reflecting the functions of peer support and intervention targets (self-efficacy, patient activation, health behaviors, social support, perceived access to care, patient-provider communication, and shared decision-making); 2b) Examine whether intermediate outcomes mediate intervention-associated differences in HRQoL; 3) Evaluate feasibility of translating VetASSIST into practice, including evaluation of per patient intervention costs and barriers and facilitators to implementation.

Official Title
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Telehealth-delivered Peer Support to Improve Quality of Life Among Veterans With Multimorbidity

Conditions
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Multimorbidity

Intervention / Treatment
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* Behavioral: Peer health coach intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veteran VA Puget Sound patient with >=1 primary care visit within last year Complex multimorbidity (>=3 chronic conditions in >=3 body systems based on AHRQ Chronic Condition Index) Meets >=2 criterion from NICE multimorbidity guidelines: 1) have a chronic physical and mental health condition (via ICD-10 codes in CDW and the CCI); 2) frailty (determined by the JEN Frailty Index available in VA data, confirmed via self-reported PRISMA-7 during the eligibility screening; 3) frequent emergency care (>=1 VA emergency department visit in past year via CDW); 4) polypharmacy (>=10 prescribed medications via CDW), or 5) significant treatment burden (score >22 on the self-reported Multimorbidity Treatment Burden Questionnaire at study screening). Inclusion criteria assessed via the phone screen includes frailty, treatment burden, and access to and willingness to use an Internet-connected device with a web camera compatible with the VA video conferencing platform Agree to participate in the health coaching sessions and surveys if assigned to intervention group Exclusion Criteria: Not fluent in English Severe hearing loss No phone access and/or missing phone number No email address Missing address Diagnosis of dementia or severe cognitive impairment within last year Diagnosis of end stage renal disease or on dialysis within last year Receipt of palliative or hospice care in the past year Receipt of nursing home care in past year (Stop codes: 650, 651,119,121) Currently living in a nursing home, skilled nursing facility, rehabilitation facility, or long-term care facility Behavior flags in EHR Active treatment for non-melanoma skin cancer diagnosis Diagnosis of substance use dependence/abuse disorder in last year (excluding tobacco) Diagnosis of psychotic disorder in last year Pregnant or planning to become pregnant in next 6 months Score of >8 (severe risk) on self-reported AUDIT-C questions on eligibility screen

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: Parallel Assignment
Interventional Model Description: Hybrid type 1 trial with 294 Veterans with multimorbidity. Participants will be randomized to one of two groups -- the control or intervention group -- in parallel for the duration of the study.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Peer health coach intervention<br>Participants will receive 20 virtual visits with a trained Veteran peer health coach over 12 months. Coaches will provide participants with brief health education, assist with goal setting and problem solving, enhance social support, and link participants to VA and community resources. | Behavioral: Peer health coach intervention<br>* Eligible participants will be randomly assigned to receive a telehealth delivered peer health coach intervention to promote health outcomes and behavior change among Veterans with multimorbidty.<br>* Other names: VetASSIST;|
| No Intervention: Control group/no intervention<br>Participants will continue to receive their regular, usual primary care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in physical health related quality of life (HRQoL) | 12 Item Short Form Health Survey (SF-12) Physical Component Summary: Summary scores for general health, physical functioning, role-physical, and bodily pain. Scaling scores will be assessed using published standardized scoring system procedures for the SF-12 found at: www.researchgate.net/publication/242636950_SF-12_How_to_Score_the_SF-12_Physical_and_Mental_Health_Summary_Scales | Baseline to 12-months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in mental health quality of life (HRQoL) | 12 Item Short Form Health Survey (SF-12) Mental Component Summary: Summary scores for vitality, mental health, social functioning, and role-emotional. Scaling scores will be assessed using published standardized scoring system procedures for the SF-12 found at: www.researchgate.net/publication/242636950_SF-12_How_to_Score_the_SF-12_Physical_and_Mental_Health_Summary_Scales | Baseline to 12-months | 
| Health care utilization | Measured by VA clinical and administrative data and self-report responses (non-VA care), including primary care, specialty care, inpatient admissions, emergency department visits. A higher number of visits indicates greater utilization. | Baseline to 12-months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Veterans, Multimorbidity, Self-management, Social support, Multiple chronic conditions, Telemedicine, Peer health coaching, Health-related quality of life