Trial Outcomes & Findings for Evaluation of Peer Specialists on VA PACTs (NCT NCT02732600)
NCT ID: NCT02732600
Last Updated: 2023-07-27
Results Overview
The Patient Activation Measure (PAM) is a 13-item survey that measures an individual's perceived ability to manage his or her illness and health behaviors and act as an effective patient. It has been shown to be reliable, valid, sensitive to change and correlates with measures of improved self-management. Scores for this outcome range from Zero to One Hundred with higher scores indicating higher levels of patient activation (better outcome).
COMPLETED
NA
5616 participants
Baseline, 6 months, 1 year
2023-07-27
Participant Flow
numbers of participants is presented at three time points: 1. Baseline 2. 6-months, and 3. 1-year
Unit of analysis: Sites
Participant milestones
| Measure |
Standard Implementation
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Overall Study
STARTED
|
3525 13
|
2091 12
|
|
Overall Study
Sub-set of Sites Newly Delivering PS Services
|
899 12
|
1484 11
|
|
Overall Study
Veteran Baseline Veteran (Sub-set of 23 Sites)
|
118 12
|
145 11
|
|
Overall Study
Veteran 6-months (Sub-set 23 Sites)
|
70 12
|
84 11
|
|
Overall Study
Veteran 1-year (Sub-set 23 Sites)
|
54 12
|
71 11
|
|
Overall Study
Peer Specialist Responses at 6-months (All 25 Sites)
|
12 13
|
14 12
|
|
Overall Study
Peer Specialist Responses at 1-year (All 25 Sites)
|
5 13
|
12 12
|
|
Overall Study
Supervisor Responses 6-months (All 25 Sites)
|
10 13
|
21 12
|
|
Overall Study
Supervisor 1-year (All 25 Sites)
|
6 13
|
10 12
|
|
Overall Study
COMPLETED
|
100 13
|
113 12
|
|
Overall Study
NOT COMPLETED
|
3425 0
|
1978 0
|
Reasons for withdrawal
Withdrawal data not reported
Baseline Characteristics
numbers vary across variables due to missing data
Baseline characteristics by cohort
| Measure |
Standard Implementation
n=194 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=221 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
Total
n=415 Participants
Total of all reporting groups
|
|---|---|---|---|
|
Age, Continuous
|
61.1 years
STANDARD_DEVIATION 10.7 • n=160 Participants • numbers vary across variables due to missing data
|
61.2 years
STANDARD_DEVIATION 13.8 • n=208 Participants • numbers vary across variables due to missing data
|
61.2 years
STANDARD_DEVIATION 12.5 • n=368 Participants • numbers vary across variables due to missing data
|
|
Sex: Female, Male
Female
|
28 Participants
n=160 Participants • numbers vary from total due to missing data
|
17 Participants
n=203 Participants • numbers vary from total due to missing data
|
45 Participants
n=363 Participants • numbers vary from total due to missing data
|
|
Sex: Female, Male
Male
|
132 Participants
n=160 Participants • numbers vary from total due to missing data
|
186 Participants
n=203 Participants • numbers vary from total due to missing data
|
318 Participants
n=363 Participants • numbers vary from total due to missing data
|
|
Race (NIH/OMB)
American Indian or Alaska Native
|
0 Participants
n=152 Participants • numbers vary due to missing data
|
0 Participants
n=196 Participants • numbers vary due to missing data
|
0 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
Asian
|
0 Participants
n=152 Participants • numbers vary due to missing data
|
0 Participants
n=196 Participants • numbers vary due to missing data
|
0 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
|
0 Participants
n=152 Participants • numbers vary due to missing data
|
0 Participants
n=196 Participants • numbers vary due to missing data
|
0 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
Black or African American
|
37 Participants
n=152 Participants • numbers vary due to missing data
|
64 Participants
n=196 Participants • numbers vary due to missing data
|
101 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
White
|
109 Participants
n=152 Participants • numbers vary due to missing data
|
121 Participants
n=196 Participants • numbers vary due to missing data
|
230 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
More than one race
|
0 Participants
n=152 Participants • numbers vary due to missing data
|
0 Participants
n=196 Participants • numbers vary due to missing data
|
0 Participants
n=348 Participants • numbers vary due to missing data
|
|
Race (NIH/OMB)
Unknown or Not Reported
|
6 Participants
n=152 Participants • numbers vary due to missing data
|
11 Participants
n=196 Participants • numbers vary due to missing data
|
17 Participants
n=348 Participants • numbers vary due to missing data
|
PRIMARY outcome
Timeframe: Baseline, 6 months, 1 yearPopulation: Comparison across two conditions on PAM Total Score - PAM Total Score (0-100)
The Patient Activation Measure (PAM) is a 13-item survey that measures an individual's perceived ability to manage his or her illness and health behaviors and act as an effective patient. It has been shown to be reliable, valid, sensitive to change and correlates with measures of improved self-management. Scores for this outcome range from Zero to One Hundred with higher scores indicating higher levels of patient activation (better outcome).
Outcome measures
| Measure |
Standard Implementation
n=194 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=221 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Patient Activation Measure Change
Baseline-PAM Total
|
41.0 Score on a scale
Standard Deviation 5.9
|
41.6 Score on a scale
Standard Deviation 6.2
|
|
Patient Activation Measure Change
6-Month-PAM Total
|
39.9 Score on a scale
Standard Deviation 5.6
|
40.6 Score on a scale
Standard Deviation 5.7
|
|
Patient Activation Measure Change
1-year-PAM Total
|
39.8 Score on a scale
Standard Deviation 6.2
|
40.8 Score on a scale
Standard Deviation 5.5
|
SECONDARY outcome
Timeframe: Baseline, 6 months, 1 yearPopulation: number of site based leadership and supervisors who responded
The Team Development Measure is a 31 item self-report survey that evaluates the degree to which a team has and uses the components needed for highly effective teamwork including cohesiveness, communication, role clarity, and goals and means clarity. All components min scores are zero % and maximum is 100%; higher percentages mean positive responses.
Outcome measures
| Measure |
Standard Implementation
n=21 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=30 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Team Development Measure
Role Clarity Baseline
|
76.0 units on a scale
Standard Deviation 28.6
|
84.4 units on a scale
Standard Deviation 16.3
|
|
Team Development Measure
Goals Baseline
|
67.9 units on a scale
Standard Deviation 38.9
|
82.0 units on a scale
Standard Deviation 29.9
|
|
Team Development Measure
Goals 1 year
|
77.5 units on a scale
Standard Deviation 24.9
|
87.5 units on a scale
Standard Deviation 17.7
|
|
Team Development Measure
Cohesiveness 6 month
|
89.6 units on a scale
Standard Deviation 21.8
|
89.1 units on a scale
Standard Deviation 23.5
|
|
Team Development Measure
Role Clarity 6 months
|
77.0 units on a scale
Standard Deviation 31.8
|
83.2 units on a scale
Standard Deviation 22.3
|
|
Team Development Measure
Communication 1 year
|
80.0 units on a scale
Standard Deviation 32.1
|
83.2 units on a scale
Standard Deviation 22.9
|
|
Team Development Measure
cohesiveness-Baseline
|
91.1 units on a scale
Standard Deviation 15.5
|
96.7 units on a scale
Standard Deviation 10.3
|
|
Team Development Measure
Communication Baseline
|
85.0 units on a scale
Standard Deviation 22.4
|
93.0 units on a scale
Standard Deviation 19.5
|
|
Team Development Measure
Communication 6 month
|
84.7 units on a scale
Standard Deviation 26.9
|
86.0 units on a scale
Standard Deviation 26.9
|
|
Team Development Measure
Goals 6 months
|
74.8 units on a scale
Standard Deviation 28.6
|
77.0 units on a scale
Standard Deviation 19.8
|
|
Team Development Measure
Cohesiveness 1 year
|
85.2 units on a scale
Standard Deviation 35.0
|
94.3 units on a scale
Standard Deviation 13.2
|
|
Team Development Measure
Role Clarity 1 year
|
70.8 units on a scale
Standard Deviation 40.6
|
82.3 units on a scale
Standard Deviation 21.5
|
SECONDARY outcome
Timeframe: 6 months, 1 yearPopulation: 6 months and 1 year
The Peer Fidelity Measure assesses: a) peer specialist services and b) peer specialist implementation. The first part has 5 domains of peer services critical to the VA's peer support model (e.g., being a role model that recovery is possible; share personal recovery story). The second has 7 domains of implementation factors shown to either help or hinder PS deployment (e.g., role clarity, support for PS at higher organizational levels, regular supervision). Each domain has 1-2 questions (responses ranging from 1= not at all through 5=Very much with higher scores indicating higher fidelity. Min Value=1 and Max value =5. The Peer Fidelity Measure will be administered to both Peer Specialists and their supervisors. Analyses looked at discrepancies (difference in difference) between Peer Specialists and their Supervisors at each time point. Min discrepancy score is -4 and Max discrepancy score is 4. (calculated as Peer Specialist minus Peer Supervisor score)
Outcome measures
| Measure |
Standard Implementation
n=8 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=19 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Peer Fidelity Measure
Peer Specialist as Liaison 6-mo
|
-0.1 units on a scale
Standard Deviation 1.2
|
1.1 units on a scale
Standard Deviation 1.4
|
|
Peer Fidelity Measure
Provides Info on Services 6 mo
|
-0.1 units on a scale
Standard Deviation 1.1
|
0.7 units on a scale
Standard Deviation 0.8
|
|
Peer Fidelity Measure
Symptoms and Medications 6-mo
|
0.2 units on a scale
Standard Deviation 2.2
|
1.0 units on a scale
Standard Deviation 2.0
|
|
Peer Fidelity Measure
Training and Preparation 6-mo
|
0.1 units on a scale
Standard Deviation 1.1
|
0.4 units on a scale
Standard Deviation 1.6
|
|
Peer Fidelity Measure
Teams Integration and Relationships 6-mo
|
-0.4 units on a scale
Standard Deviation 1.3
|
0.5 units on a scale
Standard Deviation 1.5
|
|
Peer Fidelity Measure
Role Clarity 6-mo
|
-0.3 units on a scale
Standard Deviation 1.2
|
0.2 units on a scale
Standard Deviation 1.3
|
|
Peer Fidelity Measure
Core PS functions 1-yr
|
0.7 units on a scale
Standard Deviation 0.5
|
-0.1 units on a scale
Standard Deviation 0.41
|
|
Peer Fidelity Measure
Peer Specialist as Liaison 1 year
|
0.8 units on a scale
Standard Deviation 1.1
|
-0.2 units on a scale
Standard Deviation 0.6
|
|
Peer Fidelity Measure
Core Peer Specialist 6-moFunctions
|
0.3 units on a scale
Standard Deviation 0.3
|
0.7 units on a scale
Standard Deviation 1.1
|
|
Peer Fidelity Measure
Collaborate-Promoting Health 6-mo
|
0.2 units on a scale
Standard Deviation 0.7
|
0.7 units on a scale
Standard Deviation 1.2
|
|
Peer Fidelity Measure
Leadership Support 6-mo
|
0.01 units on a scale
Standard Deviation 1.2
|
-0.2 units on a scale
Standard Deviation 0.8
|
|
Peer Fidelity Measure
Fits to Experience and Needs 6-mo
|
-0.4 units on a scale
Standard Deviation 1.6
|
-0.4 units on a scale
Standard Deviation 2.1
|
|
Peer Fidelity Measure
Resources 6-mo
|
-0.1 units on a scale
Standard Deviation 1.2
|
0.7 units on a scale
Standard Deviation 1.6
|
|
Peer Fidelity Measure
Performance Reviews 6-mo
|
-0.1 units on a scale
Standard Deviation 1.2
|
-0.1 units on a scale
Standard Deviation 2.3
|
|
Peer Fidelity Measure
Collaborate on Promoting Health 1 year
|
0.7 units on a scale
Standard Deviation 0.1
|
-0.01 units on a scale
Standard Deviation 0.6
|
|
Peer Fidelity Measure
provides info on services 1 year
|
0.0 units on a scale
Standard Deviation 0.0
|
-0.2 units on a scale
Standard Deviation 0.5
|
|
Peer Fidelity Measure
Symptoms and Medication 1 year
|
0.8 units on a scale
Standard Deviation 2.5
|
-0.1 units on a scale
Standard Deviation 2.1
|
|
Peer Fidelity Measure
Training and Preparation 1 year
|
0.5 units on a scale
Standard Deviation 1.2
|
-0.4 units on a scale
Standard Deviation 1.1
|
|
Peer Fidelity Measure
Team Integration and relationships 1 year
|
1.1 units on a scale
Standard Deviation 0.4
|
-0.2 units on a scale
Standard Deviation 0.5
|
|
Peer Fidelity Measure
Leadership Support 1 year
|
2.5 units on a scale
Standard Deviation 0.7
|
0.1 units on a scale
Standard Deviation 1.1
|
|
Peer Fidelity Measure
Fit to experience and need 1 year
|
0.0 units on a scale
Standard Deviation 2.8
|
-0.3 units on a scale
Standard Deviation 0.8
|
|
Peer Fidelity Measure
Role Clarity 1 year
|
1.3 units on a scale
Standard Deviation 1.1
|
-0.2 units on a scale
Standard Deviation 0.9
|
|
Peer Fidelity Measure
Resources
|
-0.5 units on a scale
Standard Deviation 1.4
|
-0.3 units on a scale
Standard Deviation 0.5
|
|
Peer Fidelity Measure
Performance Review 1 year
|
0.8 units on a scale
Standard Deviation 0.4
|
-0.7 units on a scale
Standard Deviation 2.2
|
SECONDARY outcome
Timeframe: Baseline, 6 months, 1 yearPopulation: Veterans responding to survey
The Satisfaction Index-Mental Health is a 12-item, unidimensional measure of patient satisfaction with care. It has been used with Veteran populations and has been shown to be valid, reliable, and sensitive to change in a sample of Veterans with mental illnesses being treated in primary care settings. It will be administered to Veterans who receive care from the Peer Specialists involved in the project. Minimum score is 12 and the maximum score is 72; higher scores mean more satisfaction.
Outcome measures
| Measure |
Standard Implementation
n=194 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=221 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
The Satisfaction Index-Mental Health
Baseline
|
47.7 units on a scale
Standard Deviation 12.1
|
51.3 units on a scale
Standard Deviation 11.5
|
|
The Satisfaction Index-Mental Health
6-months
|
49.7 units on a scale
Standard Deviation 12.7
|
52.3 units on a scale
Standard Deviation 12.6
|
|
The Satisfaction Index-Mental Health
1-year
|
50.6 units on a scale
Standard Deviation 13.0
|
51.2 units on a scale
Standard Deviation 13.6
|
SECONDARY outcome
Timeframe: one year, across two yearsPopulation: Unique Veteran encounters
This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans
Outcome measures
| Measure |
Standard Implementation
n=899 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=1 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Number of Unique Veterans Seen (Adjusted for Employment Period and Hours Worked Per Week)
1st year
|
1.3 count of Veterans
Standard Deviation 1.3
|
4.8 count of Veterans
Standard Deviation 6.1
|
|
Number of Unique Veterans Seen (Adjusted for Employment Period and Hours Worked Per Week)
across both years
|
5.8 count of Veterans
Standard Deviation 8.5
|
6.0 count of Veterans
Standard Deviation 5.8
|
SECONDARY outcome
Timeframe: across both yearsPopulation: Number of Visits per Veteran
See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans
Outcome measures
| Measure |
Standard Implementation
n=899 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=1 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (Across Both Years)
|
2.2 Count of Visits
Standard Deviation 3.0
|
3.2 Count of Visits
Standard Deviation 5.6
|
SECONDARY outcome
Timeframe: one year and across both yearsPopulation: Services Provided by each Peer Specialist
This adjusted workload variables took into consideration both the employment period (many PSs did not start immediately or may have left prior to the end of the 2 years) and weekly hours worked (varying from one hour to 40 hours per week). Visits during each PS's employment period were divided by the total number of hours worked, then multiplied by 40 to calculate adjusted values for operationalization above. Because this variable was significantly skewed, we used a log transformation to improve their distributional properties. Differences between intervention conditions were then compared with a series of Analyses of Covariance models with age, gender and race as covariates. Since these variables are measured at the PS level, the covariates were the average across the Veterans sesn by each PS (mean age, percent White and percent male). N's are number of Veterans
Outcome measures
| Measure |
Standard Implementation
n=899 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=1 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Average Total Number of Services Provided-Adjusted (First Year Only and Across Both Years)
1st Year Only
|
2.7 Count of services
Standard Deviation 2.7
|
8.4 Count of services
Standard Deviation 8.7
|
|
Average Total Number of Services Provided-Adjusted (First Year Only and Across Both Years)
Across Both Years
|
9.8 Count of services
Standard Deviation 8.7
|
12.4 Count of services
Standard Deviation 8.7
|
SECONDARY outcome
Timeframe: variable from baseline to time of first service delivered by Peer SpecialistsThis variable represents count of days from time study at each site started (baseline) until first service was delivered.
Outcome measures
| Measure |
Standard Implementation
n=16 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=21 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Time to First Service
|
188.2 Number of Days
Standard Deviation 123.4
|
88.7 Number of Days
Standard Deviation 65.0
|
SECONDARY outcome
Timeframe: 1st year onlyPopulation: number of visits per Veteran
See Variable 5 above for details about adjustment. Since this variable this is a Veteran level variable, a General Linear Mixed Model (GSLMM) was used with PS specified as a random effect and Veteran age, race and gender. N's are number of Veterans
Outcome measures
| Measure |
Standard Implementation
n=459 Participants
Standard Implementation sites will receive written guidance and limited consultation by the investigators' team.
|
Facilitated Implementation
n=767 Participants
Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation.
Facilitated Implementation: Facilitated Implementation sites will receive one year of support based on the i-PARIHS implementation model which includes training, implementation planning, ongoing external facilitation, feedback and consultation
|
|---|---|---|
|
Average Number of Visits Per Veteran Per Peer Specialist-Adjusted (First Year Only)
|
2.0 Count of Visits
Standard Deviation 2.1
|
2.6 Count of Visits
Standard Deviation 3.6
|
Adverse Events
Standard Implementation
Facilitated Implementation
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Richard Goldberg
VISN 5 Mental Illness Research, Education, and Clinical Center
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place