Comparing Strategies for Translating Self-management Support Into Primary Care

University of Colorado Denver (CU Denver)

Status: Completed

Conditions: Diabetes Mellitus, Type 2

Treatments: Behavioral: Connection to Health Interactive Behavior Change Technology; Behavioral: Connection to Health plus Coaching (CTH+C); Behavioral: Self-management support education

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01945918

12-0645

1R18DK096387-01 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This project will test different ways of helping primary care practices to do a better job of self-management support (SMS) for their patients with diabetes.

Full description

The specific aims of the proposed study are:

• Primary Specific Aims

  1. To conduct a cluster randomized trial to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of Connection to Health (CTH) for patients with type 2 diabetes in primary care practice settings. Primary effectiveness outcomes will include hemoglobin A1c, Body Mass Index (BMI), blood pressure and Low Desity Lipprotein (LDL) cholesterol.
  2. To determine the incremental benefit, using the RE-AIM framework, of brief targeted practice coaching on the implementation of CTH in diverse primary care practices.

• Secondary Specific Aims

  1. To identify key practice characteristics (e.g., practice size, organization, setting, and level of experience with practice redesign efforts) that impact CTH RE-AIM. These results will inform dissemination of the CTH intervention.
  2. To determine the relative costs associated with implementing CTH and practice coaching to further inform dissemination efforts.

Enrollment: 901 patients

Sex: All

Ages: 21 to 89 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 21 years old or over
• Type 2 Diabetes Mellitus diagnosed for a minimum of 12 months
• Able to read in English or Spanish
• Plan to remain in the practice during the study period

Exclusion criteria

• Developmentally disabled
• Decisionally challenged
• Pregnant women

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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901 participants in 3 patient groups

Self-management support education

Active Comparator group

Description:

Project staff will meet onsite with practice clinicians for a two-hour session to discuss what self-management support (SMS) is, why it is important, how primary care plays a role in this process, how others have approached it, and how it can be time and cost efficient for them to engage in SMS as part of standard diabetes care. Practices will have access to a website displaying general and local SMS resources. Discussion of the implementation of these resources into the practice will be facilitated. Two additional academic detailing visits will be made to check on progress on SMS adoption, provide additional information as needed, and answer questions. No input will be provided regarding how unique practice characteristics might be utilized for more effective implementation of SMS, and CTH will not be introduced.

Treatment:

Behavioral: Self-management support education

Connection to Health Interactive Behavior Change Technology

Active Comparator group

Description:

Connection to Health (CTH) Arm: The number and length of staff visits to these practices will be the same as for the SMS Education Arm, but the content of the visits will center on the implementation and use of the CTH program as a way to implement SMS. Clinicians and selected staff members will be given hands-on experience using the system and will be provided with scenarios that will highlight the effective use of CTH as a tool for diabetes SMS. The practices will then implement CTH, using protocols selected from several suggested by the research team. Additional technical assistance with implementing CTH will also be provided as needed.

Treatment:

Behavioral: Connection to Health Interactive Behavior Change Technology

Connection to Health plus Coaching

Experimental group

Description:

Connection to Health plus Coaching (CTH+C) Arm: This arm adds practice coaching as described above to CTH. The active coaching phase focuses on meetings of the practice improvement team, scheduled every other week for approximately 40 minutes each. The improvement team will consist of 6 - 10 diverse representatives of the practice (e.g., front office, medical assistants, physicians). The coach will assist the team in developing a CTH adoption plan and then help them break it down into small bites for rapid cycle change using the Plan-Do-Study-Act quality improvement (QI) model. Active coaching will last for 3 months, followed by monthly calls by the coach to review data regarding the practice's use of CTH and brief "booster" coaching to deal with problems.

Treatment:

Behavioral: Connection to Health plus Coaching (CTH+C)

Behavioral: Connection to Health Interactive Behavior Change Technology