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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

February 27, 2009
September 2, 2015
September 2010
May 2013   (final data collection date for primary outcome measure)
  • 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.

A1c from clinical databases [ Time Frame: 22 months ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT00854594 on ClinicalTrials.gov Archive Site
  • 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.
  • Interprofessional Education Perception Scale [ Time Frame: 22 months ] [ Designated as safety issue: No ]
  • Provider Abilities Scale - subscale from the MW Clinicians' Network [ Time Frame: 22 months ] [ Designated as safety issue: No ]
  • Team Climate inventory [ Time Frame: 22 months ] [ Designated as safety issue: No ]
  • Physician Comfort with Delegation [ Time Frame: 22 months ] [ Designated as safety issue: No ]
  • Engagement of non-MD professionals from clinical databases [ Time Frame: 12 months ] [ Designated as safety issue: No ]
  • Number of insulin starts from clinical databases [ Time Frame: 12 months ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial
Interprofessional Training for Improving Diabetes Care
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.
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.
Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
Diabetes Mellitus
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
  • 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.
    Intervention: Behavioral: Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT)
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.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
117
September 2013
May 2013   (final data collection date for primary outcome measure)

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.
Both
25 Years to 85 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00854594
EDU 08-414
No
Not Provided
Not Provided
VA Office of Research and Development
VA Office of Research and Development
  • Case Western Reserve University
  • The Cleveland Clinic
Principal Investigator: Susan R Kirsh, MD HSR&D Central Office
VA Office of Research and Development
September 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP