Improving Medical Training for the Care of Chronic Conditions

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT00676208
First received: May 7, 2008
Last updated: August 29, 2014
Last verified: August 2014

May 7, 2008
August 29, 2014
April 2008
September 2008   (final data collection date for primary outcome measure)
Evaluate the impact of SMAs on residents' and medical students' confidence, attitudes, comfort and beliefs regarding chronic care issues and management of diabetes compared to other ambulatory training experiences. [ Time Frame: 4 Months ] [ Designated as safety issue: No ]
Same as current
Complete list of historical versions of study NCT00676208 on ClinicalTrials.gov Archive Site
To assess the feasibility of using direct observation to accurately measure and compare time utilization patterns and diabetes management issues covered by trainees during patient encounters, and to identify how traditional encounters with patients with [ Time Frame: 6 months ] [ Designated as safety issue: No ]
To assess the feasibility of using direct observation to accurately measure and compare time utilization patterns and diabetes management issues covered by trainees during patient encounters, and to identify how traditional encounters with patients with [ Time Frame: 4 months ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Improving Medical Training for the Care of Chronic Conditions
Improving Medical Training for the Care of Chronic Conditions

While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland VAMC implemented a weekly Diabetes Shared Medical Appointment (SMA). Our recently published initial results and updated information for 334 patients documented improved results that have been sustained. As such, SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. In order to equip physicians with needed resources to manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined. Building on previous pilot work, the proposed pilot project includes using a think-aloud protocol to evaluate and validate new items and scales assessing interdisciplinary team and chronic care/diabetes beliefs, and evaluating and adjusting direct observation coding tools for chronic condition care.

: Most physicians receive training in and about an acute care-oriented health care system that cannot adequately address the challenges of chronic care management. While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland VAMC implemented a weekly Diabetes Shared Medical Appointment (SMA). Our recently published initial results (based on 44 SMA participants and 35 comparison patients) indicated that SMAs based on the chronic care model are effective in improving glycemic and blood pressure control in patients who are at high risk for cardiovascular morbidity including those previously labeled "non-compliant" or "non-adherent." (1) Updated information for 334 patients documented a mean change in A1c of -.9 (+/- 1.9), p<.001. The pre-SMA mean for this group was 9 (+/- 2.1) and the post-SMA was 8.4 (+/- 1.7). Thus, results from the SMAs are sustained and, as such, SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. SMAs offer the potential to provide training in crucial skills that have to date remained less amendable to traditional educational practices. In order to equip physicians with resources to effectively and efficiently manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined. Without addressing this gap, it is not possible to develop a comprehensive care model that links education and patient outcomes for chronic conditions, such as diabetes. Our aims will help define relevant parameters to assess ways SMAs impact on beliefs, attitudes, and the processes and content of encounters regarding chronic condition and interdisciplinary care for patients with diabetes. Building on previous pilot work, we will continue to address evaluating and validating instruments to inform a larger grant application. The proposed pilot project includes using a think-aloud protocol to evaluate and validate new items and scales assessing interdisciplinary team and chronic care/diabetes beliefs, and evaluating and adjusting direct observation coding tools for chronic condition care.

Interventional
Phase 0
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Diabetes Mellitus
  • Behavioral: Barriers to self-care
    16-items from Glasgow's instrument will be reworded, beliefs about how easily patients can overcome barriers to self-care
  • Behavioral: Diabetes Attitude Scale-3
    33-ite,s, UM Diabetes Research and Training Center, which measures health care professionals' attitude toward diabetes and its treatment
  • Behavioral: Challenges
    8-item scale about how often challenges are experienced by patients with diabetes (developed based on previous pilot work to assess changes in awareness and sensitivity to challenges faced by patients with chronic conditions.
  • Behavioral: Interdisciplinary teamwork scale
    8-item Partnerships for Quality Education CITE survey
  • Behavioral: Advantages of SMA
    2 Open ended items about advantages SMAs have compared to traditional appointments, and outcomes about SMAs as a way to treat patients with diabetes.
  • Behavioral: Direct Observation
    Accurately measure process and content of patient-resident encounters.
  • Active Comparator: Arm 1
    Three groups of trainees (12 in each group) will be asked to complete structured questionnaires. All participants will complete the following questionnaires (20-minutes; self-administered) at baseline and then four weeks later after experiencing 4 SMAs for the first two groups (post-assessment): 1) beliefs about how easily patients can overcome barriers to self-care 2) Diabetes Attitude Scale-3 3) an 8-item scale about how often challenges are experienced by patients with diabetes 4) interdisciplinary teamwork scale and 5) 2 open-ended items about advantages SMAs have compared to traditional appointments, and concerns about SMAs as a way to treat patients with diabetes.
    Interventions:
    • Behavioral: Barriers to self-care
    • Behavioral: Diabetes Attitude Scale-3
    • Behavioral: Challenges
    • Behavioral: Interdisciplinary teamwork scale
    • Behavioral: Advantages of SMA
  • Active Comparator: Arm 2
    Direct observation coding will be used to accurately measure process and content of patient-resident encounters, both traditional encounters and SMA-one-on-one encounters.
    Intervention: Behavioral: Direct Observation
Watts SA, Gee J, O'Day ME, Schaub K, Lawrence R, Aron D, Kirsh S. Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointments/group visits. J Am Acad Nurse Pract. 2009 Mar;21(3):167-72.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
75
February 2012
September 2008   (final data collection date for primary outcome measure)

Inclusion Criteria:

AIM and AIM 2 - Residents and Medical Students:

Inclusion:

- All residents and medical students participating in diabetes Shared Medical Appointment sessions or other training experiences during the course of the study.

Aim 2 Inclusion:

  • Attendings and other providers that the resident meets with during clinic (regular or diabetes SMAs) to discuss patient management issues.
  • Patients who the randomly selected residents see when being observed (shadowed).

Exclusion Criteria:

Aim 1 Exclusion:

- Residents and medical students who have participated in SMAs for patients with diabetes at the Cleveland VAMC in the past.

Aim 2 Exclusion:

  • Other attendings and providers.
  • Patients that the observed residents do not meet with during their scheduled clinic times
Both
20 Years to 75 Years
Yes
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00676208
SHP 08-141
No
Department of Veterans Affairs
Department of Veterans Affairs
Not Provided
Principal Investigator: David C Aron, MD MS Louis Stokes VA Medical Center
Department of Veterans Affairs
August 2014

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