An Evaluation of the Effectiveness and Acceptability of Delivering Structured Care in Chinese Type 2 Diabetic Patients (JADE-JA)
In this demonstration project (JADE in Jiangsu & Anhui Program, JADE-JA in short) led by key opinion leaders in the field of diabetes and endocrinology in Jiangsu and Anhui area and supported by the ADF, shall recruit 4800 type 2 diabetic patients attending medical out-patient clinics in the area to compare the effects of usual versus structured care (non-JADE vs JADE) on metabolic control, quality of life and behavioral changes. After explanation by trained doctors and nurses and with written informed consent, patients will be randomized to either the JADE or non-JADE group. The former encompasses all components of the structured care delivered by a trio-team of doctor, nurse and Healthcare Assistant (HCA) while the non-JADE group only consists of comprehensive assessments (CA) at baseline and 12-month with patients managed in the usual manner thereafter. At the end of 12 months, all patients will undergo repeat comprehensive assessments for comparison of rates of attainment of treatment targets, behavioral changes, quality of life and default rates. The acceptability of the JADE-JA Program by patients and the trio-team will also be evaluated.
The investigators hypothesize that the use of state of the art information technology to record, manage and analyze the large amount of clinical information generated during various consultation visits will improve the effectiveness and efficiency in implementing these care protocols through decision support and regular feedback to both patients and care team.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||A Multi-Centre Demonstration Project to Evaluate the Effectiveness and Acceptability of the Joint Asia Diabetes Evaluation (JADE) in Chinese Type 2 Diabetic Patients in Jiangsu and Anhui (JA), China|
- Percentage of patients who attain 2 or more of the 'ABC'targets [ Time Frame: 12 months ] [ Designated as safety issue: No ]
Percentage of patients who attain 2 or more of the following 3 targets:
- HbA1c <7%
- BP <130/80 mmHg
- LDL cholesterol <2.6 mmol/L
- New onset of all diabetes-related endpoints [ Time Frame: 12 months ] [ Designated as safety issue: No ]
- cardiovascular endpoints (acute myocardial infarction, revascularisation procedures, heart failure or unstable angina or arrhythmia requiring hospital admissions, stroke, lower extremity amputation or foot ulcers);
- chronic kidney disease (eGFR<60 ml/min/1.73m2) and end stage renal disease (dialysis and/or eGFR<30;ml/min/1.73m2)
- visual impairment (corrected visual acuity of 20/200 or lower) or eye surgery;
- any hospitalization due to complications related to diabetes and/or its treatment (such as hypoglycaemic attacks)
- Quality of Life [ Time Frame: 12 Months ] [ Designated as safety issue: No ]
- Behavioral changes (in the last 3 months) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
- Frequency of Self Blood Glucose Monitoring (SBGM)
- Adherence to balanced eating
- Adherence to regular exercise
- Adherence to recommended procedures (e.g. return for blood tests or education classes)
- Frequency of hypoglycaemia (in the last 3 months) [ Time Frame: 12 months ] [ Designated as safety issue: No ]
- Number of hospitalizations, follow up visits by doctors and other care professionals during the 12 months [ Time Frame: 12 months ] [ Designated as safety issue: No ]
- Default rates at the end of the study [ Time Frame: 12 months ] [ Designated as safety issue: No ]
|Study Start Date:||May 2011|
|Estimated Study Completion Date:||December 2015|
|Estimated Primary Completion Date:||December 2015 (Final data collection date for primary outcome measure)|
Experimental: JADE- JA
Use the JADE portal to monitor the delivery of structured care.
Active Comparator: Usual care
Patients will receive usual care in between two annual comprehensive assessments.
Patients will receive a comprehensive assessments at baseline and again after 12 months. In the interim between these two time points patients will be managed according to 'usual care' procedures.
In 2007, supported by an educational grant, a charitable organization named the Asia Diabetes Foundation (ADF) (www.adf.org.hk) was established to develop the Joint Asia Diabetes Evaluation (JADE) Program, which comprises a web-based disease management program to enable doctors, nurses and other care personnel to manage people with diabetes in an integrated and effective manner. The JADE electronic portal (e portal) provides a virtual platform to facilitate implementation of evidence-based clinical protocols with ongoing data collection, management and analysis to track performance for quality assurance and improvement purposes. The JADE Program also incorporates validated risk equations developed by the Chinese University of Hong Kong (CUHK) Diabetes Care & Research Group to stratify patients into various risk levels for recommendation of triage into different care protocols with decision supports. This clinical information, presented in the forms of charts and time trends, can be communicated to patients and care providers to motivate behavioral changes, set treatment goals and attain targets.
By participating in the JADE Program, the doctors will be able to create their own diabetes registry to benchmark their performance including adherence to procedures, recall of default patients and rate of attainment of treatment targets. In this regard, the implementation of the full JADE Program requires changes in the practice environment and deployment of additional manpower (e.g. a nurse and a HCA) to enter data and provide reminders to patients and doctors to improve adherence to protocols.
It is anticipated that the cost-effectiveness of the structured (JADE group) versus usual (non-JADE group) care on rates of attainment of multiple treatment targets, which will translate into clinical outcomes in the long term, will eventually change practice and policy to make quality diabetes care more affordable, sustainable and accessible in China.
In this 1-year multi-centre randomized study, the investigators shall use a web-based disease management program (JADE e portal) to facilitate implementation of structured care with the following objectives:
- To evaluate the reach, adoption and acceptability of the JADE e portal by patients and health care team
- To compare the effectiveness of the JADE versus non-JADE Program in attainment of treatment targets, improvement of quality of life and changes in behaviours
- To document the pattern of complications, risk factors, use of medications and quality of life in type 2 diabetic patients in Jiangsu and Anhui, China.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01360697
|Chinese Medicine Hospital of Anhui Province|
|Third People's Hospital of Hefei City|
|HuaiAn Second People's Hospital|
|Jiangsu Province Official Hospital|
|Rehab Hosp of Zhenjiang, Jiangsu Province|
|The Affiliated Hosp of Jiangsu-Nantong U|
|First People's Hospital of Kunshan City|
|Second Affiliated Hospital of Suzhou University|
|Principal Investigator:||Juliana Chan, MD||Asia Diabetes Foundation|
|Principal Investigator:||Gary Ko, MD||Asia Diabetes Foundation|