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

NCT ID: NCT00508014

Last Updated: 2013-10-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 727 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-12-31
• Study Completion Date: 2010-06-30

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.

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.

Conditions

Cardiovascular Diseases

Keywords

Cardiovascular disease; Diabetes; Quality improvement; Peer review

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Control

usual care

Group Type: ACTIVE_COMPARATOR

Usual Care

Intervention Type: OTHER

Usual Care with primary care provider during time period

Concurrent Peer Review Visit

See description of interventioin

Group Type: EXPERIMENTAL

Concurrent Peer Review visit

Intervention Type: BEHAVIORAL

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

Interventions

Usual Care

Usual Care with primary care provider during time period

Intervention Type: OTHER

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

Intervention Type: BEHAVIORAL

Eligibility Criteria

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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Robert Wood Johnson Foundation

OTHER

Sponsor Role: collaborator

University of Rochester

OTHER

Sponsor Role: lead

Responsible Party

Kevin Fiscella

Tenured Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Kevin Fiscella, MD, MPH

Role: STUDY_DIRECTOR

University of Rochester

Locations

Westside Health Services, Inc

Rochester, New York, United States

Countries

United States

Related Links

http://www.solvingdisparities.org/

Robert Wood Johnson Foundation Website on Grantees

Other Identifiers

59768

Identifier Type: -

Identifier Source: org_study_id