Evaluating the EAPOC-COPD System

NCT ID: NCT06852339

Last Updated: 2025-02-28

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

131 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-01

Study Completion Date

2026-09-01

Brief Summary

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The EAPOC-COPD study is a stepped wedge cluster randomized controlled trial (SW-RCT) designed to evaluate the effectiveness of the Evidence at the Point-of-Care for COPD (EAPOC-COPD) system, a digital clinical decision support system (CDSS) integrated into primary care electronic medical records (EMRs). The system aims to improve COPD management by providing personalized pharmacotherapy recommendations, symptom and risk assessments, and self-management action plans, based on patient-reported data.

Study Design:

Six primary care sites in Ontario, Canada will transition from usual care to EAPOC-COPD-supported care in a staggered manner over 56 weeks. Each site will serve as its own control during the pre-intervention period.

Primary Objective:

To assess the impact of EAPOC-COPD on guideline-aligned pharmacotherapy optimization for COPD, measured by the proportion of patients with medication escalation.

Secondary Objectives:

Evaluate improvements in symptom/risk assessments (mMRC, CAT), COPD action plan delivery, influenza vaccination, smoking cessation support provision, pulmonary rehabilitation referrals, and COPD symptom burden

Process Measures:

Study investigators will also measure provider and patient uptake, satisfaction, and system feasibility will be assessed through EMR data audits, patient/provider surveys, and system usage analytics

Population:

All prescribers at the six primary care sites (physicians and nurse practitioners) will be eligible. The study will involve patients with physician-diagnosed COPD, identified through EMR searches.

Data Collection:

Clinical outcomes will be obtained through chart reviews and data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), where available. Patient-reported outcomes will be captured via questionnaires through the patient app/portal.

Sample Size:

An estimated 1860 COPD patients will be seen during the study. With an expected baseline medication escalation rate of 13%, the study is powered to detect an 8% absolute increase (assuming an Intra Class Correlation (ICC) =0.1).

Analysis:

A generalized linear mixed model (GLMM) will assess primary and secondary outcomes, accounting for time trends, clustering, and the stepped roll out.

Significance:

This trial will generate real-world evidence on the effectiveness of a point-of-care digital tool in closing COPD care gaps, with potential for large-scale primary care implementation.

Detailed Description

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Conditions

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COPD

Keywords

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COPD clinical decision support

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Stepped wedge cluster randomized controlled trial
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors
Blinding will not be possible for participating providers or patients, given the nature of the EAPOC-COPD intervention as a point-of-care clinical decision support system integrated into routine care workflows. However, outcome assessors conducting the chart reviews will be blinded to the intervention status of the site and the period during which data were collected to minimize the risk of bias in outcome assessment.

Study Groups

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EAPOC-COPD system

The EAPOC-COPD system consists of: 1) a smart phone / tablet app or PC-based questionnaire which collects information directly from patients upon prompting, up to 1 week before their clinical appointment; and 2) a point-of-care CDSS that wirelessly receives and processes questionnaire data in order to produce a symptom severity/exacerbation risk assessment, medication change recommendation, and COPD action plan, all of which is made available to providers through a prompt, upon opening the patient chart in the existing EMR. Once approved, the personalized COPD action plan is automatically populated within the patient app/portal, enabling anywhere/anytime access for patients. Patients are also provided with educational resources within their app/portal, designed to improve health literacy, inhaler technique, and adherence to their action plan.

Group Type EXPERIMENTAL

EAPOC-COPD

Intervention Type BEHAVIORAL

The EAPOC-COPD system consists of: 1) a smart phone / tablet app or Personal Computer-based questionnaire which collects information directly from patients upon prompting, up to 1 week before their clinical appointment; and 2) a point-of-care clinical decision support system that wirelessly receives and processes questionnaire data in order to produce a symptom severity/exacerbation risk assessment, medication change recommendation, and COPD action plan, all of which is made available to providers through a prompt, upon opening the patient chart in the existing EMR. Once approved, the personalized COPD action plan is automatically populated within the patient app/portal, enabling anywhere/anytime access for patients. Patients are also provided with educational resources within their app/portal, designed to improve health literacy, inhaler technique, and adherence to their action plan

Control arm

Prior to activation of the EAPOC-COPD system, providers will provide usual care to their patients with COPD

Group Type ACTIVE_COMPARATOR

Usual Care

Intervention Type OTHER

Usual care

Interventions

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EAPOC-COPD

The EAPOC-COPD system consists of: 1) a smart phone / tablet app or Personal Computer-based questionnaire which collects information directly from patients upon prompting, up to 1 week before their clinical appointment; and 2) a point-of-care clinical decision support system that wirelessly receives and processes questionnaire data in order to produce a symptom severity/exacerbation risk assessment, medication change recommendation, and COPD action plan, all of which is made available to providers through a prompt, upon opening the patient chart in the existing EMR. Once approved, the personalized COPD action plan is automatically populated within the patient app/portal, enabling anywhere/anytime access for patients. Patients are also provided with educational resources within their app/portal, designed to improve health literacy, inhaler technique, and adherence to their action plan

Intervention Type BEHAVIORAL

Usual Care

Usual care

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Providers working at clinical site currently using IT infrastructure that allows for integration of EAPOC-COPD
* Providers caring for patients with COPD

Exclusion Criteria

* Unwilling to use EAPOC-COPD system
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Women's College Hospital

OTHER

Sponsor Role lead

Responsible Party

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Andrew Kouri

Scientist and Staff physician

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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St. Michael's Hospital, Unity Health Toronto

Toronto, Ontario, Canada

Site Status

Countries

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Canada

Central Contacts

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Andrew Kouri, MD, PhD

Role: CONTACT

Phone: (416)-864-6060

Email: [email protected]

Facility Contacts

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Andrew Kouri, MD, PhD

Role: primary

Other Identifiers

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PSI Grant Number: 24-08

Identifier Type: -

Identifier Source: org_study_id