Clinical trial NCT02386189: Pilot Study to Improve Care Coordination
Official title: Dual Health Systems Users: Strategies to Implement Optimal Care Coordination
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Chronic Illness
Keywords: Continuity of Patient Care
Health Records, Personal
Veterans
Patient Participation
Chronic Disease
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2015-03-11
Enrollment: 63
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is 1) to learn how VA patients can help share their health information between their VA providers and providers outside the VA and 2) if sharing this information is useful to providers and improves care received.

Detailed description: Recent studies estimate that 43 to 75% of Veterans also receive care from non-VA providers (dual use). Dual use is a concern because splitting care between two or more health systems and multiple providers may result in poor coordination of services and a loss of continuity -ultimately putting the patient at increased risk for poor outcomes. Addressing dual use in Veterans is an issue of care coordination. One component of care coordination is information sharing, which often relies on the patient to share information between systems/providers. Veterans registered in My HealtheVet with premium account status have access to download and print a VA health summary (VA CCD). This health summary can be shared with non-VA providers to inform them about recent VA care. This pilot randomized controlled trial will compare usual care to an intervention which aims to improve care coordination for dual use Veterans by educating them about the use of information technology to share health information and informing their providers about the extent and nature of care from other health care systems.

Methods: Dual use Veterans with at least one chronic health condition and both an upcoming VA and non-VA appointments within the study time frame will be eligible to participate. Veterans will be randomized to the intervention or usual care. Veterans in the intervention group will be trained on use of My HealtheVet and their community patient portal (if applicable) to access summary health information to share with providers. In addition, he/she will create a document that lists all members of their health care team. All participants will be asked to take a provider evaluation packet each provider visit (VA and non-VA). After the visit, a phone call will be scheduled with the Veteran to ask about the appointment and medical records from the appointment will be obtained. Outcomes: The main outcomes will be related to patient perceived continuity of care, provider relational coordination survey, medication concordance, and medical laboratory test duplication. Pre and post scores on the patient activation measures will also be explored.

Eligibility criteria: Inclusion Criteria:

VA Patient

* Receives health care from VA and non-VA provider
* Diagnosed with a chronic health condition
* Prescribed 5 or more medications
* Upcoming VA and non-VA appointments within the study time frame
* Registered or willing to become registered with My HealtheVet
* Access to a computer with internet, phone, and a printer.
* English speaking

VA or Non-VA Providers: provide care to a stuy participant

Exclusion Criteria:

* Previously shared health data with a provider via their My HealtheVet or local provider patient portal
* No scheduled VA or non-VA appointments

Primary outcomes:
measure: Patient Perceived Continuity of Care From Multiple Providers- Management Continuity
timeFrame: The time frame is from baseline assessment to 12 months post baseline during which at least one VA and one Community medical visit occurred.
measure: Patient Perceived Continuity of Care From Multiple Clinicians - Informational Continuity
timeFrame: Baseline to 12-month follow-up
measure: Patient Perceived Continuity of Care From Multiple Clinicians- Role Continuity
timeFrame: Baseline to 12-month follow-up
Secondary outcomes:
measure: Number of Participants With Duplication of Laboratory Tests
timeFrame: Baseline assessment to 12 months post-baseline, where a laboratory duplication is only counted if the medical visits occurred within three months of each other.
measure: Proportion of Medication Concordance
timeFrame: Time frame between two medical visits occuring within the one year study period
measure: Relational Coordination- VA Providers
timeFrame: Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.
measure: Relational Coordination Community Providers
timeFrame: Providers completed the coordination measure at the time of the medical visit which could occur at any point in the 12 month follow-up period.
Other outcomes:
Locations:
city: Iowa City
country: United States
facility: Iowa City VA Health Care System, Iowa City, IA
state: Iowa
Study officials:
affiliation: Iowa City VA Health Care System, Iowa City, IA
name: Carolyn L Turvey, PhD MS
role: PRINCIPAL_INVESTIGATOR
References:
citation: Haggerty JL, Roberge D, Freeman GK, Beaulieu C, Breton M. Validation of a generic measure of continuity of care: when patients encounter several clinicians. Ann Fam Med. 2012 Sep-Oct;10(5):443-51. doi: 10.1370/afm.1378.
citation: Manski-Nankervis JA, Blackberry I, Young D, O'Neal D, Patterson E, Furler J. Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. BMC Health Serv Res. 2014 Nov 1;14:515. doi: 10.1186/s12913-014-0515-3.