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Assessing the Effectiveness of Concurrent Peer Review for Patients With Cardiovascular Disease and Diabetes

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00508014
Recruitment Status : Completed
First Posted : July 27, 2007
Last Update Posted : October 14, 2013
Robert Wood Johnson Foundation
Information provided by (Responsible Party):
Kevin Fiscella, University of Rochester

Brief Summary:
We will assess the impact of concurrent peer review vists on blood pressure, cholesterol and diabetes control. Concurrent peer review (CPR) visits refer to special offic visits by patients to a clinician (physician, nurse practitioner, or physician assistant) other than than their primary care provider that are specifically designed to improve care for diabetes and cardiovascular disease.

Condition or disease Intervention/treatment Phase
Cardiovascular Diseases Other: Usual Care Behavioral: Concurrent Peer Review visit Not Applicable

Detailed Description:
This project aims to reduce racial and ethnic disparities in health care by improving cardiovascular and diabetes management among poor and minority patients. We propose to implement and evaluate an innovative, but practical intervention: CPR visits. CPR visits are designed to minimize competing demands for clinicians and reduce clinical inertia by focusing clinician and patient attention on optimizing cardiovascular and/or diabetes management and disease control and through use of clinician prompts and decision support at the point of care. Following training of clinician staff, CPR visits will be implemented within two sites of a single community health center (Westside Health Services, Inc). Patients will be randomly assigned one CPR visit with a clinician other than their primary care clinician or to usual care. The primary study outcome will include control of hypertension, diabetes, and lipids. Secondary outcomes will include process measures for cardiovascular and diabetes care. Both personnel and data collection infrastructure will build on the existing Health Disparities Collaborative at Westside. A research team from the University of Rochester will assist in the implementation of study design. This team will lead both the quantitative and qualitative evaluation of the project including outcome and process measures. Project findings offer promise for improving care to underserved populations through dissemination and implementation of a feasible strategy among practices caring for the underserved. Findings will be disseminated nationally in conjunction with the Robert Wood Johnson Foundation, the National Association of Community Health Centers, and the National Health Disparities Collaborative and through publication in the peer reviewed literature and presentation at national conferences.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 727 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Concurrent Peer Review Visits to Reduce Cardiovascular Risk Factors
Study Start Date : December 2006
Actual Primary Completion Date : June 2010
Actual Study Completion Date : June 2010

Arm Intervention/treatment
Active Comparator: Control
usual care
Other: Usual Care
Usual Care with primary care provider during time period

Experimental: Concurrent Peer Review Visit
See description of interventioin
Behavioral: Concurrent Peer Review visit
Participants are offered an office visit with a peer of their clinician primary clinician. This office visit is structured and focused on blood pressure, diabetic, and/or lipid control with decision support available at point of care

Primary Outcome Measures :
  1. Mean change in blood pressure, glycated hemoglobin, and LDL-cholesterol between baseline and follow-up [ Time Frame: 7 months ]

Secondary Outcome Measures :
  1. Use of aspirin, ACE inhibiters/ARBs (diabetic patients), pneumonia vaccine updated, diabetic foot exam, diabetic microalbumuria check, retinal exam, smoking cessation counseling, dental visit, and self management goal [ Time Frame: one year ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Active patient at Westside Health Services.
  • Currently enrolled in the Health Disparities Collaborative at WHS.
  • At least one visit to primary care provider in past year.
  • Any of the following documented during the preceding three months:
  • BP not at goal e,g. (BP 140/80 or greater unless has DM, CAD or CRI then BP greater than 130/80), LDL-C not at goal (level dependent on absolute ATP III CVD risk) or glycated hemoglogin 7 percent or higher

Exclusion Criteria:

  • Less than 18 years of age

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00508014

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United States, New York
Westside Health Services, Inc
Rochester, New York, United States, 14611
Sponsors and Collaborators
University of Rochester
Robert Wood Johnson Foundation
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Study Director: Kevin Fiscella, MD, MPH University of Rochester

Additional Information:
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Responsible Party: Kevin Fiscella, Tenured Professor, University of Rochester Identifier: NCT00508014     History of Changes
Other Study ID Numbers: 59768
First Posted: July 27, 2007    Key Record Dates
Last Update Posted: October 14, 2013
Last Verified: October 2013

Keywords provided by Kevin Fiscella, University of Rochester:
Cardiovascular disease
Quality improvement
Peer review

Additional relevant MeSH terms:
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Cardiovascular Diseases