Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial

Schwartz, Mark D.; Jensen, Ashley; Wang, Binhuan; Bennett, Katelyn; Dembitzer, Anne; Strauß, Simon; Schoenthaler, Antoinette; Gillespie, Colleen; Sherman, Scott E.

doi:10.1007/s11606-015-3204-y

Cited by 23 publications

(17 citation statements)

References 25 publications

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“…In this issue, Schwartz et al 9 report on the effects of adding nonclinical staff to perform panel management in the care of patients with hypertension and/or who smoked. In an 8-month pragmatic cluster-randomized controlled trial at two Veterans Administration (VA) primary care sites, primary care teams in the intervention groups received either panel management assistant (PMA) support or PMA support plus targeted panel management education, while control providers received monthly lists of current smokers and patients with uncontrolled hypertension.…”

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confidence: 99%

In the Office and In-Between: The Role of Panel Management in Primary Care

Kaminetzky

Nelson

2015

J GEN INTERN MED

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confidence: 99%

In the Office and In-Between: The Role of Panel Management in Primary Care

Kaminetzky

Nelson

2015

J GEN INTERN MED

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“…In the prediabetes population, the 3-year DM incidence is estimated to be 15% (based on preliminary analysis of a similar NY VA cohort from 2010 to 2012, followed through 2015). A conservative estimate of the intracluster correlation coefficient (ICC) is 0.01, based on the median value found in a systematic review of cluster randomized trials [ 34 ] and the highest value calculated in our previous VA study [ 35 ]. This planned sample size will provide at least 80% power to detect an expected difference in annual hazard rates of time to DM incidence between two arms (3.5% per year in intervention vs. 5.4% per year in control), at a 0.05 significance level.…”

Section: Methodsmentioning

confidence: 99%

Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes

et al. 2018

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BackgroundType 2 diabetes mellitus (DM) affects 9.4% of US adults and children, while another 33.9% of Americans are at risk of DM. Health care institutions face many barriers to systematically delivering the preventive care needed to decrease DM incidence. Community health workers (CHWs) may, as frontline public health workers bridging clinic and community, help overcome these challenges. This paper presents the protocol for a pragmatic, cluster-randomized trial integrating CHWs into two primary care clinics to support DM prevention for at-risk patients.MethodsThe trial will randomize 15 care teams, stratified by practice site (Bellevue Hospital and Manhattan VA), totaling 56 primary care physicians. The study cohort will consist of ~ 2000 patients who are 18–75 years of age, actively enrolled in a primary care team, able to speak English or Spanish, and have at least one glycosylated hemoglobin (HbA1c) result in the prediabetic range (5.7–6.4%) since 2012. Those with a current DM diagnosis or DM medication prescription (other than metformin) are ineligible. The intervention consists of four core activities – setting health goals, health education, activation for doctor’s appointments, and referrals to DM prevention programs – adjustable according to the patient’s needs and readiness. The primary outcome is DM incidence. Secondary outcomes include weight loss, HbA1C, and self-reported health behaviors. Clinical variables and health behaviors will be obtained through electronic medical records and surveys, respectively. Implementation outcomes, namely implementation fidelity and physicians’ perspectives about CHW integration into the clinic, will be assessed using interviews and CHW activity logs and analyzed for the influence of moderating organizational factors.DiscussionThis is the first rigorous, pragmatic trial to test the effectiveness of integrating CHWs into primary care for DM prevention reaching a population-based sample. Our study’s limitations include language-based eligibility and the use of HbA1c as a measure of DM risk. It will measure both clinical and implementation outcomes and potentially broaden the evidence base for CHWs and patient-centered medical home implementation. Further, the intervention’s unique features, notably patient-level personalization and referral to existing programs, may offer a scalable model to benefit patients at-risk of DM. Trial Registration. Clinicaltrials.gov NCT03006666 (Received 12/27/2016).

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“…This study was approved by VA's Institutional Review Board and Research and Development Committee. Additional details on the study design and primary outcomes from the trial can be found elsewhere [40,41].…”

Section: Methodsmentioning

confidence: 99%

Measuring Practicing Clinicians’ Information Literacy

Dixon

Barboza²,

Jensen

et al. 2017

Appl Clin Inform

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SummaryBackgroundAs healthcare moves towards technology-driven population health management, clinicians must adopt complex digital platforms to access health information and document care.ObjectivesThis study explored information literacy, a set of skills required to effectively navigate population health information systems, among primary care providers in one Veterans’ Affairs (VA) medical center.MethodsInformation literacy was assessed during an 8-month randomized trial that tested a population health (panel) management intervention. Providers were asked about their use and comfort with two VA digital tools for panel management at baseline, 16 weeks, and post-intervention. An 8-item scale (range 0-40) was used to measure information literacy (Cronbach’s a=0.84). Scores between study arms and provider types were compared using paired t-tests and ANOVAs. Associations between self-reported digital tool use and information literacy were measured via Pearson’s correlations.ResultsProviders showed moderate levels of information literacy (M= 27.4, SD 6.5). There were no significant differences in mean information literacy between physicians (M=26.4, SD 6.7) and nurses (M=30.5, SD 5.2, p=0.57 for difference), or between intervention (M=28.4, SD 6.5) and control groups (M=25.1, SD 6.2, p=0.12 for difference). Information literacy was correlated with higher rates of self-reported information system usage (r=0.547, p=0.001). Clinicians identified data access, accuracy, and interpretability as potential information literacy barriers.ConclusionsWhile exploratory in nature, cautioning generalizability, the study suggests that measuring and improving clinicians’ information literacy may play a significant role in the implementation and use of digital information tools, as these tools are rapidly being deployed to enhance communication among care teams, improve health care outcomes, and reduce overall costs.

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Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial

Cited by 23 publications

References 25 publications

In the Office and In-Between: The Role of Panel Management in Primary Care

In the Office and In-Between: The Role of Panel Management in Primary Care

Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes

Measuring Practicing Clinicians’ Information Literacy

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