Interactive Spaced Education to Optimize Hypertension Management

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00904007
First received: May 15, 2009
Last updated: March 28, 2014
Last verified: March 2014
  Purpose

Online interactive spaced education (ISE) is a novel educational methodology based on the "spacing effect", the psychological finding that repeated presentations of educational material over spaced intervals increase learning efficiency and improve knowledge retention. ISE is delivered using periodic emails that contain clinical case scenarios and multiple-choice question. The investigators recently completed a randomized trial involving 95 VISN 1 primary care providers (PCPs) which demonstrated that an ISE intervention can significantly improve clinician's practice patterns. Those clinicians randomized to the ISE intervention on prostate cancer screening demonstrated a 26% relative reduction in inappropriate screening. The investigators propose to conduct a randomized controlled trial involving PCPs in VISN 1 to determine whether ISE can (1) increase knowledge of the appropriate treatment of hypertensive patients, (2) reduce clinical inertia in hypertension management, and (3) improve the blood pressure control in hypertensive patients.

Anticipated Impacts on Veterans' Healthcare: This study aims to demonstrate that online interactive spaced education (ISE) can improve providers' care of patients with hypertension. ISE is the type of intervention that can be deployed across the VHA with content tailored to meet specific needs and can be implemented as a tool to improve performance measures and clinical outcomes


Condition Intervention
Hypertension
Other: Interactive Spaced Education (ISE) --- online education

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Interactive Spaced Education to Optimize Hypertension Management

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • Cross-cohort comparison of the average time needed to normalize patients' blood pressure [ Time Frame: Months 1-24 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Cross-cohort comparison of patients' average blood pressure at 12 months after trial launch (last measured blood pressure in months 1-12) [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' average change in blood pressure over months 1-12 (last measured blood pressure in months 1-12) [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' average blood pressure at 24 months after trial launch (last measured blood pressure in months 13-24) [ Time Frame: Months 13-24 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' average change in blood pressure over months 13-24 (last measured blood pressure in months 13-24) [ Time Frame: Months 13-24 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' average blood pressure at 24 months after trial launch (last measured blood pressure in months 1-24) [ Time Frame: Months 1-24 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' average change in blood pressure over months 1-24 (last measured blood pressure in months 1-24) [ Time Frame: Months 1-24 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of frequency of treatment intensification [ Time Frame: Months 1-24 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of patients' follow-up intervals after clinical encounters with elevated blood pressure [ Time Frame: Months 1-24 ] [ Designated as safety issue: No ]
  • Pre-test performance differences by provider-related variables (site of care, age, date of recertification, etc.) [ Time Frame: Month 1 ] [ Designated as safety issue: No ]
  • Cross-cohort comparison of providers' post-test scores (score improvements) [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Baseline knowledge levels of providers assessed via their initial responses to spaced education items (spaced education cohort only) [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Performance differences by provider-related variables (site of care, age, date of recertification, sex, etc.) in the spaced education program (spaced education cohort only) [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Provider-perceived acceptability of spaced education intervention [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Provider-perceived effectiveness of spaced education intervention [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Providers' perceptions of the optimal parameters for the spaced education intervention [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]
  • Provider-perceived barriers and facilitators to the spaced education intervention [ Time Frame: Months 1-12 ] [ Designated as safety issue: No ]

Enrollment: 111
Study Start Date: February 2010
Estimated Study Completion Date: September 2014
Primary Completion Date: March 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Will receive ISE intervention.
Other: Interactive Spaced Education (ISE) --- online education
ISE is a novel educational methodology based on the "spacing effect", the psychological finding that repeated presentations of educational material over spaced intervals increase learning efficiency and improve knowledge retention. ISE is delivered using periodic emails that contain clinical case scenarios and multiple-choice questions.
No Intervention: Arm 2
The control cohort will receive identical content online (with no ISE)

Detailed Description:

Anticipated Impacts on Veterans' Healthcare: This study aims to demonstrate that online interactive spaced education (ISE) can improve providers' care of patients with hypertension. ISE is the type of intervention that can be deployed across the VHA with content tailored to meet specific needs and can be implemented as a tool to improve performance measures and clinical outcomes.

Project Background/Rationale: ISE is a novel educational methodology based on the "spacing effect", the psychological finding that repeated presentations of educational material over spaced intervals increase learning efficiency and improve knowledge retention. ISE is delivered using periodic emails that contain clinical case scenarios and multiple-choice questions. We recently completed a randomized trial involving 95 VISN 1 primary care providers (PCPs) which demonstrated that an ISE intervention can significantly improve clinician's practice patterns. Those clinicians randomized to the ISE intervention on prostate cancer screening demonstrated a 26% relative reduction in inappropriate screening.

Project Objectives: Lowering blood pressure in hypertensive patients unequivocally decreases the incidence of stroke and cardiovascular events and is highly cost-effective. The majority of patients with blood pressure above the treatment target do not have their anti-hypertensive medications appropriately intensified at clinician visits. A reduced frequency of treatment intensification is alternatively termed 'clinical inertia'. Our preliminary results show that clinicians' knowledge of hypertension management guidelines is limited, and few clinicians report following the guidelines consistently. We propose to conduct a randomized controlled trial involving PCPs in VISN 1 to determine whether ISE can (1) increase knowledge of the appropriate treatment of hypertensive patients, (2) reduce clinical inertia in hypertension management, and (3) improve the blood pressure control in hypertensive patients.

Project Methods: One hundred six VISN 1 primary care practitioners (physicians, nurse practitioners, and physician assistants) will be recruited via email to participate in the study. Participants will be randomized to one of two cohorts: (1) the intervention cohort will receive ISE over year 1, and (2) the control cohort will receive no intervention and will represent the "standard of education" on hypertension management. The ISE intervention will consist of an email every 4 days containing 1 multiple-choice questions based on a curriculum derived from clinical practice guidelines on appropriate hypertension management. Providers will submit answers to the questions online and immediately receive the correct answer and an explanation of the pertinent clinical issues. Using a new adaptive methodology, the spacing and content of the educational intervention will be individualized for each clinician based on their performance. The ISE intervention will be completed in 9-11 months. Hypertension knowledge will be assessed by a post-test at the end of year 1. Providers' clinical inertia and the blood pressures of their patients will be assessed over 2 years: initial changes attributable to ISE will be identified in year 1, while the retention of these changes will be monitored in year 2. Drawing on the interdisciplinary expertise of our investigator team, the study is positioned to enrich national debates about how best to improve the ways in which clinicians can meet their lifelong learning needs.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • VA VISN 1 primary care clinicians (MD, NP, PA) who have at least a 50% (4/8 time) clinical appointment.

Exclusion Criteria:

  • VA VISN 1 primary care clinicians (MD, NP, PA) who do not have at least a 50% (4/8 time) clinical appointment.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00904007

Locations
United States, Massachusetts
VA Boston Healthcare System, Brockton Campus
Brockton, Massachusetts, United States, 02301
Sponsors and Collaborators
Investigators
Principal Investigator: B. Price Kerfoot, MD EdM VA Boston Healthcare System, Brockton Campus
  More Information

No publications provided by Department of Veterans Affairs

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT00904007     History of Changes
Other Study ID Numbers: EDU 08-422
Study First Received: May 15, 2009
Last Updated: March 28, 2014
Health Authority: United States: Federal Government

Keywords provided by Department of Veterans Affairs:
Educational Technology
Hypertension
Education, Professional

Additional relevant MeSH terms:
Hypertension
Vascular Diseases
Cardiovascular Diseases

ClinicalTrials.gov processed this record on August 01, 2014