Clinical trial NCT04822480: Evaluation of a Telehealth DPP With Medicare Patients at the University of Mississippi Medical Center
Official title: A Telehealth Diabetes Prevention Program in an Academic Medical Center Setting: Hybrid Type III Trial
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: PreDiabetes
Prediabetic State
Keywords: diabetes prevention
Lead sponsor: University of Mississippi Medical Center
Sponsor class: OTHER
Collaborators: name: American Medical Association
name: Mississippi State Department of Health
First posted: 2021-03-30
Enrollment: 500
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Mississippi consistently has among the highest rates of diabetes (14.3%) and prediabetes (36.5%) nationally and is the only state where every county (82 counties) are represented in the Diabetes Belt, a geographic region of the U.S. where the prevalence of diagnosed diabetes is highest. Mississippi has the fourth largest rural population (51.2%) and the highest state percent Black (37.8%) population in the U.S., and has persistently high rates of poverty (20.8%).

Brief summary: The National Diabetes Prevention Program (DPP) is an evidence-based, 12-month lifestyle change program to prevent or delay the onset of type 2 diabetes mellitus (herein referred to as 'diabetes') among adults with prediabetes. The Department of Preventive Medicine, University of Mississippi Medical Center (UMMC), in partnership with the American Medical Association, is collaborating to develop and implement the DPP as a clinical service for UMMC patients beginning in September 2020. We aim to recruit 245 patients per year over 3 years. Because this is the first attempt to develop and implement the DPP as a clinical service at the UMMC, we are proposing to conduct a comprehensive process, outcome, impact and return on investment evaluation. An effectiveness-implementation hybrid research design will be used to (1) evaluate a multifaceted implementation strategy and the effectiveness and impact of the DPP delivered using telehealth by UMMC's Department of Preventive Medicine; (2) conduct an analysis on medical expenditures among those who participate in a DPP to measure net savings and return on investment (ROI) relative to non-participants; (3) conduct a longitudinal cohort analysis to assess incidence of diabetes and changes in body composition, biomarkers, and psycho-social behavioral constructs among those who participate in a DPP relative to those who do not.

The findings from this comprehensive research evaluation will be used to (1) improve clinical operations and implementation; (2) demonstrate the cost benefit of the DPP as a clinical service for patients with diabetes risk; and (3) provide empirical support for delivering the DPP via different modalities including telehealth to reduce risk and improve health outcomes among patients.

Detailed description: The purpose of this research is to: (1) Evaluate a multifaceted implementation strategy for the uptake of a remote DPP by UMMC's Department of Preventive Medicine. (2) Conduct an analysis on medical expenditures among those who participate in a DPP to measure net savings and ROI relative to non-participants. (3) Conduct a longitudinal cohort analysis to assess incidence of diabetes, body composition, biomarkers, and psycho-social behavioral constructs among those who participate in a DPP relative to those who do not. Study methods are described below according to each of three specific aims.

Aim 1: Conduct a concurrent implementation and effectiveness evaluation of the DPP in a clinical care setting for patients with prediabetes (n=245). An effectiveness-implementation hybrid type III research design will be used to conduct a non-randomized trial with 245 of patients with prediabetes over a three year recruitment period, while employing an iterative process evaluation to explore the complex processes, dynamic context and organizational influences on implementation. The RE-AIM framework will guide the implementation and effectiveness evaluation including measures of Reach, Effectiveness, Adoption, Implementation and Maintenance. Multiple data sources and data types will be used to assess barriers and facilitators that affect the RE-AIM domains, as well as fidelity, costs, patient satisfaction and physician burnout.

Aim 2: Utilize claims and encounters data to measure medical expenditures for patients with prediabetes, and determine spending differentials among DPP participants compared with non-DPP participants. Track trends in per capita medical expenditures for among a panel of case (DPP participant) and control (Non-DPP participant) subjects. To compare variations in spending, the differences in the arithmetic means, compound annual growth rates, and propensity score matching models will be implemented to compare case and control subjects. The study may also look at those with prediabetes that are later diagnosed with diabetes and individuals with prediabetes who are not later diagnosed with the condition. These estimates of spending differentials and evidence of DPP participation and engagement rates will help to further enhance the algorithm to estimate the potential cost savings and ROI if diabetes is prevented or delayed in the at-risk population who participate in the DPP.

Aim 3: Assess the longitudinal effect of the DPP on participant changes in cardiovascular disease risk including anthropometric and clinical biomarker and psychosocial health outcomes (N=245). A prospective, repeated measures, experimental cohort design will be used to determine the long-term impact of the DPP on diabetes incidence and cardiovascular disease risk among DPP patient participants.

Eligibility criteria: Inclusion Criteria:

* UMMC patient within the previous 3-years (at least one UMMC clinical visit within the previous 3-years)
* ≥ 18 years AND
* Clinical diagnosis for prediabetes (R73.03)

OR any of the following combinations:

* BMI ≥25 (non-Asian) OR
* BMI ≥23 (Asian) AND
* HbA1c 5.7 - 6.4 percent within the past 12-months OR
* Fasting plasma glucose 110 - 125 mg/dL within the past 12-months OR
* 2-hour plasma glucose 140 - 199 mg/dL within the past 12-months

Exclusion Criteria:

* Pregnant or planning to become pregnant within the next 12 months
* \<18 years
* Primary or secondary diagnosis of diabetes mellitus (all codes with prefix of 250 and 249) and other conditions associated with diabetes (357.2, all codes with prefix 362, 366.41, and all codes with prefix 648).
* End stage renal disease

Primary outcomes:
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 6-months in DPP compared with non-DPP patients
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 12-months in DPP compared with non-DPP patients
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 18-months in DPP compared with non-DPP patients
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 24-months in DPP compared with non-DPP patients
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 30-months in DPP compared with non-DPP patients
measure: Type 2 diabetes mellitus diagnosis
timeFrame: Change diabetes diagnosis from baseline to 36-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 6-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 12-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 18-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 24-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 30-months in DPP compared with non-DPP patients
measure: Hemoglobin A1c
timeFrame: Change in HbA1c from baseline to 36-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 6-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 12-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 18-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 24-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 30-months in DPP compared with non-DPP patients
measure: Fasting plasma glucose
timeFrame: Change in fasting plasma glucose from baseline to 36-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 6-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 12-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 18-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 24-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 30-months in DPP compared with non-DPP patients
measure: 2-hour plasma glucose
timeFrame: Change in 2-hour plasma glucose from baseline to 36-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 6-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 12-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 18-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 24-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 30-months in DPP compared with non-DPP patients
measure: Medical encounters
timeFrame: Number of medical encounters between baseline and 36-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 6-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 12-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 18-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 24-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 30-months in DPP compared with non-DPP patients
measure: Medical expenditures
timeFrame: Medical expenditures from baseline to 36-months in DPP compared with non-DPP patients
Secondary outcomes:
measure: Body weight
timeFrame: Change in body weight from baseline to 6-months
measure: Body weight
timeFrame: Change in body weight from baseline to 12-months
measure: Body weight
timeFrame: Change in body weight from baseline to 24-months
measure: Body weight
timeFrame: Change in body weight from baseline to 36-months
measure: Fat mass
timeFrame: Change in fat mass from baseline to 6-months
measure: Fat mass
timeFrame: Change in fat mass from baseline to 12-months
measure: Fat mass
timeFrame: Change in fat mass from baseline to 24-months
measure: Fat mass
timeFrame: Change in fat mass from baseline to 36-months
measure: Visceral fat
timeFrame: Change in visceral fat from baseline to 6-months
measure: Visceral fat
timeFrame: Change in visceral fat from baseline to 12-months
measure: Visceral fat
timeFrame: Change in visceral fat from baseline to 24-months
measure: Visceral fat
timeFrame: Change in visceral fat from baseline to 36-months
measure: Skeletal muscle mass
timeFrame: Change in skeletal muscle mass from baseline to 6-months
measure: Skeletal muscle mass
timeFrame: Change in skeletal muscle mass from baseline to 12-months
measure: Skeletal muscle mass
timeFrame: Change in skeletal muscle mass from baseline to 24-months
measure: Skeletal muscle mass
timeFrame: Change in skeletal muscle mass from baseline to 36-months
measure: Waist circumference
timeFrame: Change in waist circumference from baseline to 6-months
measure: Waist circumference
timeFrame: Change in waist circumference from baseline to 12-months
measure: Waist circumference
timeFrame: Change in waist circumference from baseline to 24-months
measure: Waist circumference
timeFrame: Change in waist circumference from baseline to 36-months
measure: Systolic blood pressure
timeFrame: Change in systolic blood pressure from baseline to 6-months
measure: Systolic blood pressure
timeFrame: Change in systolic blood pressure from baseline to 12-months
measure: Systolic blood pressure
timeFrame: Change in systolic blood pressure from baseline to 24-months
measure: Systolic blood pressure
timeFrame: Change in systolic blood pressure from baseline to 36-months
measure: Diastolic blood pressure
timeFrame: Change in diastolic blood pressure from baseline to 6-months
measure: Diastolic blood pressure
timeFrame: Change in diastolic blood pressure from baseline to 12-months
measure: Diastolic blood pressure
timeFrame: Change in diastolic blood pressure from baseline to 24-months
measure: Diastolic blood pressure
timeFrame: Change in diastolic blood pressure from baseline to 36-months
measure: Resting heart rate
timeFrame: Change in resting heart rate from baseline to 6-months
measure: Resting heart rate
timeFrame: Change in resting heart rate from baseline to 12-months
measure: Resting heart rate
timeFrame: Change in resting heart rate from baseline to 24-months
measure: Resting heart rate
timeFrame: Change in resting heart rate from baseline to 36-months
measure: Total cholesterol
timeFrame: Change in total cholesterol from baseline to 6-months
measure: Total cholesterol
timeFrame: Change in total cholesterol from baseline to 12-months
measure: Total cholesterol
timeFrame: Change in total cholesterol from baseline to 24-months
measure: Total cholesterol
timeFrame: Change in total cholesterol from baseline to 36-months
measure: HDL cholesterol
timeFrame: Change in HDL cholesterol from baseline to 6-months
measure: HDL cholesterol
timeFrame: Change in HDL cholesterol from baseline to 12-months
measure: HDL cholesterol
timeFrame: Change in HDL cholesterol from baseline to 24-months
measure: HDL cholesterol
timeFrame: Change in HDL cholesterol from baseline to 36-months
measure: Triglycerides
timeFrame: Change in triglycerides from baseline to 6-months
measure: Triglycerides
timeFrame: Change in triglycerides from baseline to 12-months
measure: Triglycerides
timeFrame: Change in triglycerides from baseline to 24-months
measure: Triglycerides
timeFrame: Change in triglycerides from baseline to 36-months
measure: Hemoglobin A1c (point of care)
timeFrame: Change in HbA1c from baseline to 6-months
measure: Hemoglobin A1c (point of care)
timeFrame: Change in HbA1c from baseline to 12-months
measure: Hemoglobin A1c (point of care)
timeFrame: Change in HbA1c from baseline to 24-months
measure: Hemoglobin A1c (point of care)
timeFrame: Change in HbA1c from baseline to 36-months
measure: Self-efficacy for weight loss and maintenance
timeFrame: Change in self-efficacy from baseline to 6-months
measure: Self-efficacy for weight loss and maintenance
timeFrame: Change in self-efficacy from baseline to 12-months
measure: Self-efficacy for weight loss and maintenance
timeFrame: Change in self-efficacy from baseline to 24-months
measure: Self-efficacy for weight loss and maintenance
timeFrame: Change in self-efficacy from baseline to 36-months
measure: Readiness to change, stage of change
timeFrame: Change in stage of change from baseline to 6-months
measure: Readiness to change, stage of change
timeFrame: Change in stage of change from baseline to 12-months
measure: Readiness to change, stage of change
timeFrame: Change in stage of change from baseline to 24-months
measure: Readiness to change, stage of change
timeFrame: Change in stage of change from baseline to 36-months
measure: Readiness to change, processes of change
timeFrame: Change in processes of change from baseline to 6-months
measure: Readiness to change, processes of change
timeFrame: Change in processes of change from baseline to 12-months
measure: Readiness to change, processes of change
timeFrame: Change in processes of change from baseline to 24-months
measure: Readiness to change, processes of change
timeFrame: Change in processes of change from baseline to 36-months
measure: Decisional balance
timeFrame: Change in decisional balance from baseline to 6-months
measure: Decisional balance
timeFrame: Change in decisional balance from baseline to 12-months
measure: Decisional balance
timeFrame: Change in decisional balance from baseline to 24-months
measure: Decisional balance
timeFrame: Change in decisional balance from baseline to 36-months
measure: Self-efficacy for overcoming barriers to physical activity and healthy eating
timeFrame: Change in barrier self-efficacy from baseline to 6-months
measure: Self-efficacy for overcoming barriers to physical activity and healthy eating
timeFrame: Change in barrier self-efficacy from baseline to 12-months
measure: Self-efficacy for overcoming barriers to physical activity and healthy eating
timeFrame: Change in barrier self-efficacy from baseline to 24-months
measure: Self-efficacy for overcoming barriers to physical activity and healthy eating
timeFrame: Change in barrier self-efficacy from baseline to 36-months
measure: Self-regulation of eating behaviors
timeFrame: Change in self-regulation of eating behaviors from baseline to 6-months
measure: Self-regulation of eating behaviors
timeFrame: Change in self-regulation of eating behaviors from baseline to 12-months
measure: Self-regulation of eating behaviors
timeFrame: Change in self-regulation of eating behaviors from baseline to 24-months
measure: Self-regulation of eating behaviors
timeFrame: Change in self-regulation of eating behaviors from baseline to 36-months
measure: Self-regulation of physical activity - goals
timeFrame: Change in self-regulation of physical activity goals from baseline to 6-months
measure: Self-regulation of physical activity - goals
timeFrame: Change in self-regulation of physical activity goals from baseline to 12-months
measure: Self-regulation of physical activity - goals
timeFrame: Change in self-regulation of physical activity goals from baseline to 24-months
measure: Self-regulation of physical activity - goals
timeFrame: Change in self-regulation of physical activity goals from baseline to 36-months
measure: Self-regulation of physical activity - planning
timeFrame: Change in self-regulation of physical activity planning from baseline to 6-months
measure: Self-regulation of physical activity - planning
timeFrame: Change in self-regulation of physical activity planning from baseline to 12-months
measure: Self-regulation of physical activity - planning
timeFrame: Change in self-regulation of physical activity planning from baseline to 24-months
measure: Self-regulation of physical activity - planning
timeFrame: Change in self-regulation of physical activity planning from baseline to 36-months
measure: Social support from friends - eating
timeFrame: Change in social support from baseline to 6-months
measure: Social support from friends - eating
timeFrame: Change in social support from baseline to 12-months
measure: Social support from friends - eating
timeFrame: Change in social support from baseline to 24-months
measure: Social support from friends - eating
timeFrame: Change in social support from baseline to 36-months
measure: Social support from family - eating
timeFrame: Change in social support from baseline to 6-months
measure: Social support from family - eating
timeFrame: Change in social support from baseline to 12-months
measure: Social support from family - eating
timeFrame: Change in social support from baseline to 24-months
measure: Social support from family - eating
timeFrame: Change in social support from baseline to 36-months
measure: Social support from friend - physical activity
timeFrame: Change in social support from baseline to 6-months
measure: Social support from friend - physical activity
timeFrame: Change in social support from baseline to 12-months
measure: Social support from friend - physical activity
timeFrame: Change in social support from baseline to 24-months
measure: Social support from friend - physical activity
timeFrame: Change in social support from baseline to 36-months
measure: Social support from family - physical activity
timeFrame: Change in social support from baseline to 6-months
measure: Social support from family - physical activity
timeFrame: Change in social support from baseline to 12-months
measure: Social support from family - physical activity
timeFrame: Change in social support from baseline to 24-months
measure: Social support from family - physical activity
timeFrame: Change in social support from baseline to 36-months
measure: Outcome expectancies
timeFrame: Change in outcome expectancies from baseline to 6-months
measure: Outcome expectancies
timeFrame: Change in outcome expectancies from baseline to 12-months
measure: Outcome expectancies
timeFrame: Change in outcome expectancies from baseline to 24-months
measure: Outcome expectancies
timeFrame: Change in outcome expectancies from baseline to 36-months
measure: Coping self-efficacy
timeFrame: Change in coping self-efficacy from baseline to 6-months
measure: Coping self-efficacy
timeFrame: Change in coping self-efficacy from baseline to 12-months
measure: Coping self-efficacy
timeFrame: Change in coping self-efficacy from baseline to 24-months
measure: Coping self-efficacy
timeFrame: Change in coping self-efficacy from baseline to 36-months
Other outcomes:
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 3-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 6-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 9-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 12-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 15-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 18-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 21-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 24-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 27-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 30-months
measure: Eligible DPP patients (reach)
timeFrame: Baseline to 33-months
measure: Patients eligible for DPP (reach)
timeFrame: Baseline to 36-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 3-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 6-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 9-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 12-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 15-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 18-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 21-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 24-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 27-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 30-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 33-months
measure: Patients referred to DPP (reach)
timeFrame: Baseline to 36-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 3-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 6-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 9-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 12-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 15-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 18-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 21-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 24-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 27-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 30-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 33-months
measure: Patients enrolled in DPP (reach)
timeFrame: Baseline to 36-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 3-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 6-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 9-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 12-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 15-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 18-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 21-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 24-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 27-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 30-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 33-months
measure: Referring clinical sites (adoption)
timeFrame: Baseline to 36-months
measure: Referring providers (adoption)
timeFrame: Baseline to 3-months
measure: Referring providers (adoption)
timeFrame: Baseline to 6-months
measure: Referring providers (adoption)
timeFrame: Baseline to 9-months
measure: Referring providers (adoption)
timeFrame: Baseline to 12-months
measure: Referring providers (adoption)
timeFrame: Baseline to 15-months
measure: Referring providers (adoption)
timeFrame: Baseline to 18-months
measure: Referring providers (adoption)
timeFrame: Baseline to 21-months
measure: Referring providers (adoption)
timeFrame: Baseline to 24-months
measure: Referring providers (adoption)
timeFrame: Baseline to 27-months
measure: Referring providers (adoption)
timeFrame: Baseline to 30-months
measure: Referring providers (adoption)
timeFrame: Baseline to 33-months
measure: Referring providers (adoption)
timeFrame: Baseline to 36-months
measure: Implementation
timeFrame: Continuous processual evaluation
Locations:
city: Jackson
country: United States
facility: University of Mississippi Medical Center
state: Mississippi
Study officials:
affiliation: University of Mississippi Medical Center
name: Abigail Gamble, PhD, MS
role: PRINCIPAL_INVESTIGATOR
affiliation: American Medical Association
name: Tamkeen Khan, PhD
role: PRINCIPAL_INVESTIGATOR
References: