The purpose of this study is to measure the evidence-based intervention's (EBIs) impact on patient safety and efficiency, to assess the EBIs implementation by measuring acceptability, appropriateness, cost, fidelity, penetration, and sustainability and to identify the facilitators and barriers that influence the degree of implementation of these EBIs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
450
we designed an enhanced team process entailing: 1) using automated abnormal test result detection and tracking; 2) expanding the primary care team to include CPs to guide the evaluation of anemia to identify underlying causes; and 3) using NNs to engage patients in the healthcare team and diagnostic process and increase patient activation.
Usual care involves primary care physicians ordering additional tests and referrals to evaluate patients with new anemia and decreased glomerular filtration rate (GFR) .
The University of Texas Health Science Center at Houston
Houston, Texas, United States
RECRUITINGPercentage of subjects who have correct diagnosis of cause of low hemoglobin
Percentage of subjects who have correct diagnosis of cause of low hemoglobin
Time frame: within 6 months from baseline
Percentage of subjects who have correct diagnosis of cause of low glomerular filtration
Percentage of subjects who have correct diagnosis of cause of low glomerular filtration
Time frame: within 6 months from baseline
Time until diagnosis
Time until diagnosis is defined as number of days from the initial abnormal test result to the day the diagnosis was communicated to the patient.
Time frame: initial abnormal test result to the day the diagnosis was communicated to the patient (about 1-6 months)
Percentage of tests appropriately utilized
Percentage of tests appropriately utilized will be calculated as the number of appropriate tests ordered to evaluate the abnormal test divided by the total number of tests ordered to evaluate the abnormal test, multiplied by 100.
Time frame: within 6 months from baseline
Cost of treatment
Costs will be assessed from the health care system perspective and will include the costs of all diagnostic tests and referral consultations to evaluate the abnormal tests, emergency department (ED) visits or admissions for care for the underlying diseases causing test abnormalities, and the personnel time to provide the EBIs during the 6-month work up period.
Time frame: from baseline to 6 months
Number of primary care physicians (PCPs) who find the intervention as acceptable assessed by survey of PCPs
Number of primary care physicians (PCPs) who find the intervention as acceptable
Time frame: 12 weeks after PCP's patient enrolled
Number of PCPs who find the intervention appropriate as assessed by survey of PCPs
Number of PCPs who find the intervention appropriate as assessed by survey of PCPs
Time frame: 12 weeks after PCP's patient enrolled
Number of PCPs who find the intervention feasible as assessed by survey of PCPs
Number of PCPs who find the intervention feasible as assessed by survey of PCPs
Time frame: 12 weeks after PCP's patient enrolled
Fidelity as assessed by the percentage of participants who moved through each step of the diagnostic process needed for their diagnosis
Fidelity as assessed by the percentage of participants who moved through each step of the diagnostic process needed for their diagnosis
Time frame: 6 months
Penetration as assessed by the percentage of participants with abnormal tests who receive the intervention
Penetration as assessed by the percentage of participants with abnormal tests who receive
Time frame: 6 months
Sustainability as assessed by number of clinics that continued the intervention
Time frame: 2.5 years
Patient activation as assessed by the short form of the Patient Activation Measure (PAM)
This 13-item survey uses a 5-point Likert scale to measure 4 domains related to patient activation. Total score ranges from 1 to 65, with a higher score indicating greater activation.
Time frame: between 1 to 6 months
Number of clinics with more facilitators than barriers
Number of clinics with more facilitators than barriers
Time frame: 6 months
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