Enhancing Engagement by Integrating Goals and Concerns That Matter to Patients
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-100
SponsorDartmouth-Hitchcock Medical Center
About this trial
The goal of this clinical trial is to learn if adding patients' goals and concerns to measurement-based collaborative care can tailor care and provide a more holistic view of treatment, thereby improving engagement in care among adult patients receiving collaborative care. The main questions it aims to answer are:
* Does using a clinical decision support system (which includes an enhanced pre-visit questionnaire and patient-level dashboard) improve patient engagement in the collaborative care model? * Does using a clinical decision support system improve patient and clinician satisfaction with care?
Researchers will compare the enhanced collaborative care with traditional collaborative care.
Patient participants will complete pre-visit questionnaires before their collaborative care appointments. Responses will be viewed by the clinician and/or patient in a visual dashboard inside the electronic health record.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Patients enrolled in the Collaborative Care Model (CoCM) at Dartmouth Health
Disqualifiers
Patients not enrolled in the Collaborative Care Model (CoCM) at Dartmouth Health
Trial design
Design model
Crossover
Treatments tested in this trial
Collaborative care model with clinical decision support system
BehavioralA new patient-level clinical decision support system (CDSS) will include enhancing the existing pre-visit questionnaire to capture patient-reported goals and concerns, and displaying pre-visit questionnaire responses and clinical information within a patient-level dashboard in the electronic health record (EHR) for use by clinicians and patients.
Collaborative care model
BehavioralCollaborative care model of integrated behavioral health and primary care.
Treatment groups
2,448 Participants
are divided into 2 treatment groupsGroup A: Clinical Decision Support SystemExperimental treatment 1 intervention
Group B: Collaborative care model (usual care)Active comparator 1 intervention
Trial outcomes
Primary outcomes
1
Engagement
The primary outcome measure targeted is increased Collaborative Care Model (CoCM) engagement as measured by the proportion of CoCM patients with 2 or more Patient Health Questionnaire (PHQ-9)/Generalized Anxiety Disorder (GAD-7) assessments completed.
Time frame
From enrollment in CoCM to discharge from CoCM, approximately 3-4 months.2
Patient and clinician satisfaction and barriers/facilitators to implementation
Qualitative data collected through semi-structured interviews.
Time frame
From enrollment in CoCM to discharge from CoCM, approximately 3-4 months.Secondary outcomes
1
Practice-level communication: Shared decision-making
Practice-level communication will be assessed using the collaboRATE measure of shared decision making. The collaboRATE survey includes three questions, rated from 0 (no effort was made) to 4 (every effort was made). Responses will be scored using the Top Score approach which excludes cases where a response to one or more of the collaboRATE questions is missing. Each encounter is coded as either '1', if the response to all three collaboRATE items was 4, or '0' if the response to any of the three collaboRATE items was less than 4. The percentage of all encounters that were coded as '1' is the collaboRATE Score. Higher scores represent more shared decision making.
Time frame
Approximately 1 month following enrollment in CoCM2
Patient experience: Communication
Communication will be assessed using the "Communication with Mental Health Counselor" composite measure from the CAHPS Outpatient Mental Health Survey, which includes two questions: "In the last 6 months, how often did your main mental health counselor listen carefully to you? In the last 6 months, how often did your main mental health counselor show respect for what you had to say?" (Response options: never, sometimes, usually, always). The score for the composite measure is equal to the mean of the proportion of responses (excluding missing data) in each response category across the items in the composite, where the numerator is the number of people responding "always" and the denominator for each question is the total number of responses. Higher scores indicate higher quality communication.
Time frame
Approximately 1 month following enrollment in CoCM3
Patient experience: Goal setting
Goal setting will be assessed using a single question from the CAHPS Outpatient Mental Health Survey: "In the last 6 months, how much did your main mental health counselor consider what is important to you when setting the goals for treatment?" (Response options: not at all, a little, some, a lot). The score is equal to the proportion of responses (excluding missing data) who indicate the top answer "a lot", divided by the total number of responses. Higher proportions indicate higher goal setting.
Time frame
Approximately 1 month following enrollment in CoCM4
Treatment response: Depression
Change in depressive symptoms will be determined based on the scores obtained from the Patient Health Questionnaire-9 (PHQ-9). The total score can range from 0 to 27. Higher scores indicate greater severity of depression.
Time frame
From enrollment in CoCM to discharge from CoCM, approximately 3-4 months.Sponsors and contacts
Click on the lead sponsor to view all of their trials.
Dartmouth-Hitchcock Medical Center
Lead sponsor
Trustees of Dartmouth College
Sponsor institution
National Center for Advancing Translational Sciences (NCATS)
Collaborator
Dartmouth College
Collaborator
Source ClinicalTrials.gov