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Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial (ReSPECT)

This study has been completed.
Sponsor:
Collaborators:
Case Western Reserve University
The Cleveland Clinic
Information provided by (Responsible Party):
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT00854594
First received: February 27, 2009
Last updated: September 2, 2015
Last verified: September 2015
  Purpose
The investigators' study focuses on improving the care of diabetes, a complex chronic illness, by providing important insights into interprofessional training and its potential role in fostering the necessary interdisciplinary management needed for chronic conditions and in addressing the gap between best practice and actual care provided.

Condition Intervention
Diabetes Mellitus
Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: Interprofessional Training for Improving Diabetes Care

Further study details as provided by VA Office of Research and Development:

Primary Outcome Measures:
  • Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network [ Time Frame: Baseline ] [ Designated as safety issue: No ]

    Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities:

    1. Instruct patients on home glucose monitoring
    2. Teach foot care
    3. Teach insulin administration
    4. Instruct patients about diet
    5. Help patients make changes in their diets that you have recommended
    6. Instruct patients about regular exercise
    7. Help patients make changes in their exercise habits that you have recommended
    8. Identify candidates for long-acting insulin
    9. Interpret glucose patterns
    10. Adjust insulin in insulin-treated patients with poor glycemic control
    11. Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin
    12. Manage patients with poor glycemic control
    13. Initiate insulin therapy (NPH or insulin glargine and aspart)
    14. Apply principles of diabetes care in a team setting

    Averages of provider efficacy were calculated across all activities.


  • Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network [ Time Frame: 22 months (post-intervention) ] [ Designated as safety issue: No ]

    Providers asked to indicate their level of confidence on an 11-point scale, with 0 indicating 'not at all confident' and 10 indicating 'extremely confident' for the following activities:

    1. Instruct patients on home glucose monitoring
    2. Teach foot care
    3. Teach insulin administration
    4. Instruct patients about diet
    5. Help patients make changes in their diets that you have recommended
    6. Instruct patients about regular exercise
    7. Help patients make changes in their exercise habits that you have recommended
    8. Identify candidates for long-acting insulin
    9. Interpret glucose patterns
    10. Adjust insulin in insulin-treated patients with poor glycemic control
    11. Do you feel comfortable knowing whether to titrate basal insulin versus bolus insulin
    12. Manage patients with poor glycemic control
    13. Initiate insulin therapy (NPH or insulin glargine and aspart)
    14. Apply principles of diabetes care in a team setting

    Averages of provider efficacy were calculated across all activities.



Secondary Outcome Measures:
  • Attitudes Toward Healthcare Teams Scale and Subscales [ Time Frame: Baseline ] [ Designated as safety issue: No ]
    A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.

  • Attitudes Toward Healthcare Teams Scale and Subscales [ Time Frame: 22 months (post-intervention) ] [ Designated as safety issue: No ]
    A validated scale developed to assess attitudes towards teams in a healthcare setting with three subscales to assess attitudes toward team value, attitudes toward team efficiency, and attitudes towards physician's shared role on a team. Each of the 21 items is rated 1 to 6, ranging from 'Strongly Disagree' to 'Strongly Agree'. The scale was considered 'complete' for analysis among providers who answered at least 7 of the 21 items. Items were reverse-coded as specified in the subscale development publication. Averages across completed items were calculated within provider. Higher values corresponded with more positive attitudes towards teams.


Enrollment: 117
Study Start Date: September 2010
Study Completion Date: September 2013
Primary Completion Date: May 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: Control
Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.
Experimental: ReSPECT Intervention
Intervention sites will receive baseline measures pre and post, but also in-depth Shared Medical Appointments (SMA)(The Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT) intervention) and at 15 months SMA video conferences. At the end of the 18 months the randomly selected patients and providers will be asked to take part in a qualitative interview.
Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)
The intervention is designed to educate the clinicians at intervention CBOCs by modeling interprofessional team practices during SMAs for diabetes mellitus (DM) patients from each CBOC primary care provider's (PCP) patient panel. We hypothesize that this education at intervention CBOCs will improve interprofessional practices and overall quality care delivered to veterans.
Other Name: ReSPECT

Detailed Description:
The complexity of diabetes management challenges the acute care-oriented healthcare system. Some experts suggest part of the problem is that the healthcare system fosters a separate silos decision making model. While there is increasing recognition that quality diabetes care is best provided in an interdisciplinary manner, interprofessional training models are limited, as is understanding of the links between interprofessional training, actual practice, and patient outcomes. Advancing our understanding of interprofessional training models is critical because most of the complications associated with diabetes (e.g., amputations, renal failure, strokes) can be prevented or delayed with proper management. The investigators' objective is to better understand the processes and mechanisms by which interprofessional training impacts on chronic care management (practice patterns) and the ways it translates into improved patient outcomes.
  Eligibility

Ages Eligible for Study:   25 Years to 85 Years   (Adult, Senior)
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

CLINICIANS

  • All clinicians in all of Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study (all PCPs have patients with DM in their panel of patients).

PATIENTS

  • All diabetic patients who are seen in Ohio's CBOCs (except for the Georgetown CBOC) will be eligible for the study.

Exclusion Criteria:

CLINICIANS

  • Any clinician who does not have diabetic patients on their panel, who aren't apart of Ohio's CBOC's, or see patients at the Georgetown CBOC will not be eligible to participate.

PATIENTS

  • Patients who don't have a diagnosis of diabetes, who aren't seen at one of Ohio's CBOC's, or is seen for their medical care at the Georgetown CBOC will not be eligible to participate.
  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: NCT00854594

Locations
United States, Ohio
Louis Stokes VA Medical Center
Cleveland, Ohio, United States, 44106-3800
Sponsors and Collaborators
VA Office of Research and Development
Case Western Reserve University
The Cleveland Clinic
Investigators
Principal Investigator: Susan R Kirsh, MD HSR&D Central Office
  More Information

Publications:
Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT00854594     History of Changes
Other Study ID Numbers: EDU 08-414 
Study First Received: February 27, 2009
Results First Received: June 11, 2015
Last Updated: September 2, 2015
Health Authority: United States: Federal Government

Keywords provided by VA Office of Research and Development:
Diabetes
Telemedicine
Shared Medical Appointments

Additional relevant MeSH terms:
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases

ClinicalTrials.gov processed this record on December 08, 2016