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

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

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 or disease	Intervention/treatment	Phase
Diabetes Mellitus	Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)	Not Applicable

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.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	117 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Prevention
Official Title:	Interprofessional Training for Improving Diabetes Care
Study Start Date :	September 2010
Actual Primary Completion Date :	May 2013
Actual Study Completion Date :	September 2013

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
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

Outcome Measures

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Primary Outcome Measures :

1. Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network [ Time Frame: Baseline ]

   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.

2. Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network [ Time Frame: 22 months (post-intervention) ]

   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 :

1. Attitudes Toward Healthcare Teams Scale and Subscales [ Time Frame: Baseline ]
   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.
2. Attitudes Toward Healthcare Teams Scale and Subscales [ Time Frame: 22 months (post-intervention) ]
   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.

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	25 Years to 85 Years (Adult, Senior)
Sexes Eligible for Study:	All
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

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

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

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications of Results:

Kirsh SR, Schaub K, Aron DC. Shared medical appointments: a potential venue for education in interprofessional care. Qual Manag Health Care. 2009 Jul-Sep;18(3):217-24. doi: 10.1097/QMH.0b013e3181aea27d.

Responsible Party:	VA Office of Research and Development
ClinicalTrials.gov Identifier:	NCT00854594 History of Changes
Other Study ID Numbers:	EDU 08-414
First Posted:	March 3, 2009
Results First Posted:	October 6, 2015
Last Update Posted:	October 6, 2015
Last Verified:	September 2015

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