Pilot Study to Improve Care Coordination

VA Office of Research and Development

Status: Completed

Conditions: Chronic Illness

Treatments: Behavioral: Patient Care Coordination Training

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT02386189

SDR 14-392

Details and patient eligibility

About

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.

Full 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.

Enrollment: 63 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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63 participants in 2 patient groups

Usual Care

No Intervention group

Description:

Veterans randomized to usual care will not receive any training on using their patient portal(s) to access and share information. They will be contacted via phone and/or secure messaging to remind him/her to take the VA or non-VA provider packet to their appointment. At the conclusion of the study, Veterans assigned to usual care will be provided the training information on the VA health summary for their own reference.

Care Coordination

Active Comparator group

Description:

Veterans in this group will share a comprehensive list of all of their providers (VA and non-VA) at future appointments. He/she will also be trained on how to create a VA Health Summary in My HealtheVet to share with their non-VA providers and how to use their community portals (if available) to share information back to VA providers. A VA and non-VA provider visit will be evaluated.

Treatment:

Behavioral: Patient Care Coordination Training