Using Multimedia Patient Feedback to Reduce Disparities in VA Healthcare

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00914485
First received: June 3, 2009
Last updated: August 28, 2013
Last verified: August 2013
  Purpose

The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare.


Condition Intervention
Primary Care
Behavioral: Provider Communication Skills Training

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Using Multimedia Patient Feedback to Reduce Disparities in VA Healthcare

Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • improve physician communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients. [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Enrollment: 376
Study Start Date: December 2009
Study Completion Date: March 2013
Primary Completion Date: February 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm 1
Provider clinical communication training intervention
Behavioral: Provider Communication Skills Training
Consists of 4 separate 1-hour sessions, 1 per "best act," in which physicians view 3 video-recorded performances of each act performed by trained actors of varied race/ethnicity.

Detailed Description:

The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare. We have identified 4 "best acts" of physician communication that patients believe to be most important in a clinical interaction. We propose to develop and evaluate a physician communication intervention that focuses specifically on these acts. In addition, our abundance of pilot study data from patients of various races/ethnicities enables us to create an intervention applicable to communication that spans patient race/ethnicity. Evaluating this intervention with physicians and patients in 2 independent VA primary care settings will help determine whether a patient-driven communication focus that incorporates input from patients of varied race/ethnicity can help "close the gap" in health outcomes between white and minority veterans.

We aim to (1) demonstrate the efficacy of using "best acts" of physician communication as content for an intervention to improve physician communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients, and (2) assess the impact of patient experiences of "best acts" on patients' perceptual and behavioral outcomes.

We have collected data from over 200 primary care patients as they viewed a video of themselves and their physician interacting during a clinic visit. From these data, we are developing an educational intervention for physicians that focuses specifically on the 4 "best acts" we have identified. Scripts of the 4 "best acts" will be developed, and standardized patients at Baylor College of Medicine will perform the acts, which will be video recorded. We will then conduct a 2-site longitudinal observational study of 16 primary care physicians (8 at each site) and 36 patients of each physician. At the first site at 3-month intervals, physicians will attend an instruction session consisting of viewing a video of one best act and participating in group discussion, role-playing re-enactment of the act, and formulation of bulleted "take-away" points to facilitate subsequent recall. Once completed, the sequence of sessions will occur at the second site. At both sites, clinical interactions of participating physicians and patients will be audio recorded, and audio recordings will be analyzed for frequency of occurrence of the 4 "best acts." After each study visit, each patient will complete validated surveys measuring patients' perceptions of their physician on 4 affective dimensions known to impact patients' subsequent perceptual and behavioral outcomes. Efficacy will be assessed across patient demographics.

  Eligibility

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

Inclusion Criteria:

Any patient included in the regular panel of a participating physician at either study site who is a returning patient for that physician. Since 2 of the patient perceptual measures included require the pre-existence of a relationship with a specific physician, we will only enroll patients who have been seen by their physician before.

Exclusion Criteria:

  • Physical disabilities that prohibit unassisted participation in research protocol:

    • legal blindness
    • dementia
    • severe post-traumatic stress disorder
    • schizophrenic disorder
    • Alzheimer's disease
    • bipolar disorder
    • and severe anxiety and/or mood disorders (must be documented in patient's medical record or attested to by patient, physician or charge nurse).
  • Also, no patients new to VA primary care or to a given participating physician will be enrolled.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00914485

Locations
United States, Louisiana
Southeast Louisiana Veterans Health Care System
New Orleans, Louisiana, United States, 70112
United States, Texas
Michael E DeBakey VA Medical Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
Investigators
Principal Investigator: P. Adam Kelly, PhD MBA BS Southeast Louisiana Veterans Health Care System
  More Information

No publications provided

Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT00914485     History of Changes
Other Study ID Numbers: IIR 07-194
Study First Received: June 3, 2009
Last Updated: August 28, 2013
Health Authority: United States: Federal Government

ClinicalTrials.gov processed this record on April 15, 2014