Clinician engagement

March 4, 2022: ACP COVID: A Trial to Evaluate an Advance Care Planning Video and Communication Skills Training Intervention for Older Adults During an Evolving Pandemic (Angelo E. Volandes, MD, MPH; James A. Tulsky, MD; Sophia N. Zupanc, BA)

Posted on by terren.green@duke.edu

Speaker

Angelo E. Volandes, MD, MPH
Associate Professor, Harvard Medical School and Massachusetts General Hospital

James A. Tulsky, MD
Chair, Department of Psychosocial Oncology and Palliative Care
Dana-Farber Cancer Institute
Professor of Medicine, Harvard Medical School

Sophia N. Zupanc, BA
Dana-Farber Cancer Institute

Keywords

Advanced Care Planning; VitalTalk; ACP DECISIONS; Unstructured data; Patient engagement; Clinician engagement

Key Points

  • ACP COVID combines the VitalTalk program and ACP DECISIONS videos to help patients and families navigate difficult decisions around advanced care planning.
  • VitalTalk is a non-profit organization providing evidence-based communication training. VitalTalk trained health care providers to communicate advanced care planning options with patients.
  • The ACP COVID study compared advanced care planning documentation rates at three specific timepoints: 6 months prior to COVID-19(control period, Sep 2019-Mar 2020), during the first wave of COVID-19(control period, March 2020-Sep 2020), and during the time period when vaccines were first rolled out in New York state(intervention period, Dec 2020-June 2021).
  • Advanced care planning conversations best happen in the outpatient setting, not in the hospital right before intubation.
  • Almost 24% of patients in the intervention period had Advance Care Planning conversations which was significantly higher than the control periods.

Discussion Themes

The clinician training program gave clinicians the skills to cope with the implications of the pandemic and led to increased clinician engagement.

 

 

Read more about ACP-COVID.

 

 Tags

#pctGR, @Collaboratory1

October 29, 2020: Article Describes Perspectives for Engaging Front-line Clinicians in PCTs

Posted on by Gina Uhlenbrauck

Ellen Tambor, MA, and colleagues have recently published in Learning Health Systems a PCORI-funded study of clinician perspectives on participating in pragmatic clinical trials (PCTs). In One size does not fit all: Insights for engaging front-line clinicians in pragmatic clinical trials, the authors wanted to better understand how clinicians view their role in research in the context of health care delivery, and what might be the common barriers to engagement. The authors describe results from focus group discussions conducted with physicians, nurses, and other care providers as the first phase of their study. The second phase involved key informant interviews with PCT research teams and clinicians participating in ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness), the first pragmatic trial to leverage PCORI’s National Patient-Centered Clinical Research Network (PCORnet).

Funding mechanisms that allow adequate time and flexibility for protocol development (eg, the UG3/UH3 model employed for the NIH Health Care Systems Research Collaboratory Trials) can allow for more meaningful use of clinician feedback. (Tambor et al. 2020)

This study partly arose from early work in the NIH Collaboratory’s Stakeholder Engagement Core, which was established to disseminate best practices and guidelines for conducting research studies in partnership with healthcare systems to a broad audience of stakeholders. Read more in the Living Textbook in Building Partnerships and Teams to Ensure a Successful Trial.

May 14, 2020: Healthcare Workers Invited to Join the HERO Registry

Posted on by Gina Uhlenbrauck

The Healthcare Worker Exposure Response & Outcomes (HERO) Registry invites both clinical and nonclinical healthcare workers to share their life experiences in order to understand the perspectives and problems faced by those on the COVID-19 pandemic frontlines. HERO Registry participants could have the opportunity to participate in future research studies to improve the understanding of COVID-19 and beyond, generating evidence to help healthcare workers stay safe and healthy.

The HERO Registry is open to all healthcare workers, including nurses, therapists, physicians, emergency responders, food service workers, environmental service workers, interpreters, transporters — anyone who works in a setting where people receive health care.

Learn more about the HERO Registry and how to join.

Don’t miss the recent COVID-19 Grand Rounds introducing the HERO Program and get the latest information and resources on COVID-19 for clinical researchers.

August 23, 2019: Oh Yes, We Have Tons of Patients Who Can Do This Study! (Vanita R. Aroda, MD)

Posted on by Gina Uhlenbrauck

Speaker

Vanita R. Aroda, MD
Director of Diabetes Clinical Research
Brigham & Women’s Hospital
Harvard Medical School

Topic

Oh Yes, We Have Tons of Patients Who Can Do This Study!

Keywords

Patient engagement; Patient recruitment and retention; Clinician engagement; Health care systems; Multicenter clinical trials; Electronic health record

Key Points

  • Research occurs beyond the silo. Effective large-scale multicenter clinical trial recruitment requires an accessible network of potential participants.
  • Engage colleagues and the healthcare system as part of the collaborative journey across the trial’s lifecycle.
  • It is highly recommended to do a role-playing exercise with the study team to prevent fumbles when engaging and recruiting study participants.
  • The science, the protocols, and the data are all important, but it is the essential human element that makes it all happen.

Discussion Themes

Participant retention is really a continuation of good recruitment and engagement.

Make sure your database query makes clinical sense and is the best fit to answer your study question. Don’t spend time on the wrong data.

What other recruitment opportunities or techniques can sites use after they exhaust their patient panel?

Read more about the scalability of an EHR-based approach to patient recruitment in a diabetes study by Dr. Varoda and colleagues in Clinical Trials (2019).

Tags

#pctGR, @Collaboratory1

May 3, 2019: Effect of Financial Bonus Sizes, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: A Randomized Trial and Cohort Study (Amol Navathe, MD, PhD)

Posted on by Gina Uhlenbrauck

Speaker

Amol S. Navathe, MD, PhD
Assistant Professor of Medicine and Health Policy
University of Pennsylvania

Topic

Effect of Financial Bonus Sizes, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: A Randomized Trial and Cohort Study

Keywords

Behavioral economics; Performance incentives; Evidence-based quality-of-care measures; Primary care quality; Pay for performance; Value-based medicine

Key Points

  • Pay-for-performance (P4P) programs are increasingly being used by health insurers and healthcare systems to incentivize physicians to practice higher value medicine, yet the evidence for P4P to affect quality and value of care remains mixed.
  • Behavioral economic principles in this study included increased social pressure and loss aversion added to larger bonus sizes to evaluate whether the intervention would lead to higher achievement of evidence-based quality measures.

Discussion Themes

Study findings included that, while a larger bonus size was associated with significantly improved quality for chronic care patients relative to a propensity-matched comparison group, adding increased social pressure and the opportunity for loss aversion did not lead to further quality improvement.

Attrition during the trial contributed some variability to the analysis.

Read more about pay for performance in healthcare in JAMA Network Open (Navathe et al, 2019) and NEJM Catalyst (2018).

Tags

#behavioraleconomics, #pctGR, @Collaboratory1

Minimizing the Burden of Practical Research: Case Studies from the NIH Collaboratory

Posted on by Gina Uhlenbrauck

In a forthcoming article in Healthcare, Dr. Eric Larson and colleagues present practical advice based on case studies from the National Institutes of Health (NIH) Health Care Systems Research Collaboratory. Physician–scientists, health services researchers, and delivery system leaders provide insight from their experience launching a pragmatic clinical trial (PCT) as part of the Collaboratory.

The authors make 5 recommendations:

  • Establish a partnership from the get-go
  • Do a pilot project
  • Take advantage of existing hospital and health system infrastructure
  • Minimize the impact on clinical workflow
  • Remember that even high-priority research questions must be balanced with the systems’ greatest priority: providing good healthcare to patients.

The authors note that researchers need to be flexible and prepared to adjust the study design to the workflow and culture of the system.

Reference: Larson E, Tachibana C, Thompson E, et al. Trials without tribulations: Minimizing the burden of pragmatic research on healthcare systems. Healthcare. 2015; in press. doi:10.1016/j.hjdsi.2015.07.005

Watch Dr. Larson’s Grand Rounds Presentation from June 2013: Trials, Not Tribulations: Minimizing the Burden of Research on Health Care Systems