An interventional study of Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT) in Diabetes Mellitus, sponsored by US Department of Veterans Affairs. Completed at 1 site in United States. Open to participants aged 25 Years to 85 Years. Per ClinicalTrials.gov, last updated 2015-10-06.
Sponsored by US Department of Veterans Affairs · Not applicable, Interventional, and Prevention
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.
10,925 studies on the registry are indexed under Diabetes Mellitus; 1,319 are open to participants now.
This study's enrollment of 117 is above the median of 80 across 8,367 interventional studies indexed under Diabetes Mellitus.
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CLINICIANS
PATIENTS
Exclusion Criteria:
CLINICIANS
PATIENTS
Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.
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.
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.
Also known as: ReSPECT
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network
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.
Time frame: Baseline
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network
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.
Time frame: 22 months (post-intervention)
Attitudes Toward Healthcare Teams Scale and Subscales
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.
Time frame: Baseline
Attitudes Toward Healthcare Teams Scale and Subscales
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.
Time frame: 22 months (post-intervention)
| Milestone | Control | ReSPECT Intervention |
|---|---|---|
| Started | 48 | 69 |
| Completed | 48 | 69 |
| Not completed | 0 | 0 |
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.
| units on a scale | Control | ReSPECT Intervention |
|---|---|---|
| Attitudes Toward Healthcare Teams Scale and Subscales | 4.42 ± .52 | 4.29 ± .55 |
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.
| units on a scale | Control | ReSPECT Intervention |
|---|---|---|
| Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network | 6.89 ± 2.17 | 6.41 ± 1.90 |
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.
| units on a scale | Control | ReSPECT Intervention |
|---|---|---|
| Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network | 7.09 ± 2.05 | 6.88 ± 2.14 |
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.
| units on a scale | Control | ReSPECT Intervention |
|---|---|---|
| Attitudes Toward Healthcare Teams Scale and Subscales | 4.44 ± 0.52 | 4.24 ± 0.59 |
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Control | — | 0/48 (0%) | 0/48 (0%) |
| ReSPECT Intervention | — | 0/69 (0%) | 0/69 (0%) |
For providers who completed the survey once, using demographics reported; for providers who completed the survey twice, using demographics from earlier survey completion.
| Age, Customized(participants) | Control | ReSPECT Intervention | Total |
|---|---|---|---|
| Missing | 0 | 4 | 4 |
| 39 years or less | 7 | 12 | 19 |
| 40 to 59 years | 41 | 48 | 89 |
| 60 years or greater | 0 | 5 | 5 |
| Sex/Gender, Customized(participants) | Control | ReSPECT Intervention | Total |
|---|---|---|---|
| Male | 12 | 13 | 25 |
| Female | 36 | 53 | 89 |
| Unknown | 0 | 3 | 3 |
This study is completed, as verified in Sep 2015. You cannot join it, but the record below documents what was studied.
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US Department of Veterans Affairs