Trial Outcomes & Findings for Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial (NCT NCT00854594)

NCT ID: NCT00854594

Last Updated: 2015-10-06

Results Overview

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.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 117 participants
• Primary outcome timeframe: Baseline
• Results posted on: 2015-10-06

Participant Flow

Cleveland and Cincinnati CBOCs (excluding Georgetown; n = 18 CBOCs) were the study sites randomized to the two study arms. Providers within site were subject to the intervention to which the site was randomized and the questionnaire responses were collected at the provider level.

Participant milestones

Measure	Control Providers within sites randomized to the control arm will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention Providers within sites randomized to the intervention arm 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. Role modeling in Shared medical appointments to Promote Establishing Collaborative Teams (ReSPECT): The intervention is designed to educate the clinicians at intervention Community-Based Outpatient Clinics (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.
Overall Study STARTED	48	69
Overall Study COMPLETED	48	69
Overall Study NOT COMPLETED	0	0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Interprofessional Training to Improve Diabetes Care: The ReSPECT Trial

Baseline characteristics by cohort

Measure	Control n=48 Participants Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention n=69 Participants 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. 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 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.	Total n=117 Participants Total of all reporting groups
Age, Customized Missing	0 participants n=5 Participants	4 participants n=7 Participants	4 participants n=5 Participants
Age, Customized 39 years or less	7 participants n=5 Participants	12 participants n=7 Participants	19 participants n=5 Participants
Age, Customized 40 to 59 years	41 participants n=5 Participants	48 participants n=7 Participants	89 participants n=5 Participants
Age, Customized 60 years or greater	0 participants n=5 Participants	5 participants n=7 Participants	5 participants n=5 Participants
Sex/Gender, Customized Male	12 participants n=5 Participants	13 participants n=7 Participants	25 participants n=5 Participants
Sex/Gender, Customized Female	36 participants n=5 Participants	53 participants n=7 Participants	89 participants n=5 Participants
Sex/Gender, Customized Unknown	0 participants n=5 Participants	3 participants n=7 Participants	3 participants n=5 Participants

PRIMARY outcome

Timeframe: Baseline

Population: Providers within sites randomized to control and intervention arms were surveyed at baseline; 39 control arm providers and 55 intervention arm providers completed the ability items of the survey.

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.

Outcome measures

Measure	Control n=39 Participants Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention n=55 Participants 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. 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 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.
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network	6.89 units on a scale Standard Deviation 2.17	6.41 units on a scale Standard Deviation 1.90

PRIMARY outcome

Timeframe: 22 months (post-intervention)

Population: Providers within sites randomized to control and intervention arms were surveyed after the intervention period; 20 control arm providers and 29 intervention arm providers completed the ability items of the survey.

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.

Outcome measures

Measure	Control n=20 Participants Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention n=29 Participants 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. 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 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.
Provider Abilities Scale - Subscale From the Midwest (MW) Clinicians' Network	7.09 units on a scale Standard Deviation 2.05	6.88 units on a scale Standard Deviation 2.14

SECONDARY outcome

Timeframe: Baseline

Population: Providers within sites randomized to control and intervention arms were surveyed at baseline; 39 control arm providers and 53 intervention arm providers complete the attitude scale of the survey.

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.

Outcome measures

Measure	Control n=39 Participants Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention n=53 Participants 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. 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 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.
Attitudes Toward Healthcare Teams Scale and Subscales	4.42 units on a scale Standard Deviation .52	4.29 units on a scale Standard Deviation .55

SECONDARY outcome

Timeframe: 22 months (post-intervention)

Population: Providers within sites randomized to control and intervention arms were surveyed after the intervention period; 20 control arm providers and 29 intervention arm providers completed the attitude scale of the survey.

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.

Outcome measures

Measure	Control n=20 Participants Control sites will receive the baseline measures pre and post. These sites will receive traditional diabetes education, which includes teleconsultation.	ReSPECT Intervention n=29 Participants 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. 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 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.
Attitudes Toward Healthcare Teams Scale and Subscales	4.44 units on a scale Standard Deviation 0.52	4.24 units on a scale Standard Deviation 0.59

Adverse Events

Control

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

ReSPECT Intervention

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Jeneen Shell-Boyd

Louis Stokes VA Medical Center

Phone: (216) 791-2300

Email: Jeneen.shell-boyd@va.gov

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place