Implementing Scalable, PAtient-centered, Team-based, Technology-enabled Care for Adults With Type 2 Diabetes (iPATH)

NCT ID: NCT06251323

Last Updated: 2025-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

119680 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-30

Study Completion Date

2028-01-31

Brief Summary

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Sixteen institutions will be selected from a HRSA uniform data system and have data collected for up to 3 years. Eight institutions will begin the iPATH practice transformation during year one, the other eight institutions will begin iPATH in year two. FQHC administrators, clinicians and staff will be enrolled to participate in the iPATH transformation in their clinic and will participate in qualitative interviews. Patient HbA1c data from the clinics will be collected for comparative data analysis during each year of the study.

Detailed Description

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A collaborative network of research teams from Stanford, Harvard, The Ohio State University, and Impactivo, LLC propose practice-relevant research focused on diabetes care in federally qualified health centers (FQHCs). Some 37.3 million Americans have type 2 diabetes. FQHCs are an important source of diabetes care for one in ten Americans and shoulder a higher prevalence of diabetes (21% FQHC, 11% U.S.), offering a promising venue for innovating in diabetes care. The iPATH project will refine and implement an approach to practice transformation originally conceived to support FQHCs' pursuit of National Committee for Quality Assurance recognition as patient-centered medical homes. A pilot demonstrated significant decreases (average 31% reduction) in poorly controlled diabetes (A1c\>9%) among patients at 7 clinics affiliated with an FQHC in Puerto Rico in 2017-20. Improvements in patients' diabetes control were sustained pre- to post- Covid-19 pandemic.

Aim 1. Refine the iPATH implementation approach by identifying organizational conditions and processes at FQHCs that promoted or impeded the effectiveness of type 2 diabetes care. Research teams will simultaneously conduct 12 in-depth regional case studies, enabling contrast between FQHCs considered high-performing and low-performing for diabetes control. Teams will identify actionable, how-to implementation factors for ensuring chronic, preventive, and acute care for patients with diabetes. Employing an innovative Rapid Data Collection and Reporting methodology, teams will rapidly collect, analyze, and share data to accelerate dissemination of customized feedback to FQHC leaders and to inform adaptation and implementation of the iPATH practice transformation.

Aim 2. Implement a multi-level, multi-component, technology-enabled practice transformation strategy to improve type 2 diabetes for patients at 8 multi-clinic FQHCs. Teams will adapt, tailor, implement, test, and spread our practice transformation strategy across FQHCs located in California, Massachusetts, Ohio, and Puerto Rico. The iPATH implementation approach will be modularized and customizable to accommodate organizational readiness, patient needs, and social contexts, tailoring practice transformation efforts to each unique FQHC.

Aim 3. Comprehensively evaluate the iPATH implementation approach with a hybrid type 2 study, including a stepped wedge cluster randomized trial. Including formative, process, and summative evaluation elements guided by the Exploration-Preparation-Implementation-Sustainment model, the study will evaluate impact of practice transformation and identify process elements affecting implementation effectiveness. Analyses will leverage the unique advantage of FQHC data.

Conditions

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Diabetes Mellitus, Type 2

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Wave 1 Clinics

Clinics will have data evaluated for up to 3 years. Wave 1 clinics will begin the iPATH practice transformation in Year 1.

Group Type EXPERIMENTAL

iPATH implementation approach

Intervention Type OTHER

A multi-level, multi-component, customized, standardized, technology enabled, person-centered, and team-based care practice transformation strategy.

Wave 2 Clinics

Clinics will have data evaluated for up to 3 years. Wave 2 clinics will begin the iPATH practice transformation in Year 2.

Group Type EXPERIMENTAL

iPATH implementation approach

Intervention Type OTHER

A multi-level, multi-component, customized, standardized, technology enabled, person-centered, and team-based care practice transformation strategy.

Interventions

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iPATH implementation approach

A multi-level, multi-component, customized, standardized, technology enabled, person-centered, and team-based care practice transformation strategy.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Two largest clinic sites in multi-clinic FQHCs operating in or near Massachusetts, Ohio, California, Puerto Rico
* We will prioritize FQHCs performing in the lower half of the distribution for A1c control, as these FQHCs have greater room for improvement.

Exclusion Criteria

* FQHCs that have a patient population comprised of more than 80% children
* FQHCs that have a patient population multiplied by the FQHC's diabetes prevalence in the lowest 10% of all the clinics
* FQHCs that have fewer than 5,000 or more than 50,000 patients.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Ohio State University

OTHER

Sponsor Role collaborator

Harvard School of Public Health (HSPH)

OTHER

Sponsor Role collaborator

Impactivo, LLC.

UNKNOWN

Sponsor Role collaborator

National Institute on Minority Health and Health Disparities (NIMHD)

NIH

Sponsor Role collaborator

Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Sara Singer

Professor of Health Policy, of Medicine (Primary Care & Population Health), by courtesy, of Organizational Behavior at the Graduate School Of Business and Senior Fellow, by courtesy, at The Freeman Spogli Institute For International Studies

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Board of Trustees of the Leland Stanford Junior University

Stanford, California, United States

Site Status RECRUITING

President and Fellows of Harvard College, T.H. Chan School

Boston, Massachusetts, United States

Site Status RECRUITING

The Ohio State University

Columbus, Ohio, United States

Site Status RECRUITING

Impactivo, LLC.

San Juan, Puerto Rico, Puerto Rico

Site Status RECRUITING

Countries

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United States Puerto Rico

Facility Contacts

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Sara Singer, PhD

Role: primary

650-498-5354

Michaela Kerrissey, PhD

Role: primary

617-432-4520

Daniel Walker, PhD

Role: primary

614-293-2428

Maria Levis, MPH, MPA

Role: primary

787-565-1227

Other Identifiers

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72410

Identifier Type: -

Identifier Source: org_study_id

1R01MD017870-01A1

Identifier Type: NIH

Identifier Source: secondary_id

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