View clinical trials related to Delivery of Health Care.
Filter by:50 children/adolescents (ages 6 to <18yrs) with T1D in suboptimal control (HbA1c≥8.0%) and lower SES (below 200% poverty line) on insulin therapy (either injections or open-loop pumps) will be recruited at Nemours ~ 1/3 each AA, Hispanic/Latino, non-Hispanic whites. All families that qualify and agree to transition to closed-loop technologies will be recruited to allow data to be gathered before and after use of devices. They will go through the process of approval with the assistance of an insurance navigator in clinic. Those not a CGM will be prescribed one as well. Diabetes care will be 'real life', devices will be prescribed, and care per clinic routine with periodic device downloads. Principal outcome, time-in-range, will be analyzed at 3-months compared to baseline, each participant their own control. Secondary outcomes including HbA1c, other glucose metrics and questionnaires related to use of technology and diabetes distress will be also analyzed. All outcomes will also be collected at 6-months. Results could have important and fast applicability to the field and help better inform decision makers, including payers, clinicians, and patients and families and could serve to decrease health care disparities in this needy population.
The COVID-19 pandemic has transformed the delivery of ambulatory care in the US. One of the most notable changes to ambulatory care practice has been the rapid expansion of telemedicine services. Such expansion sought to preserve access to necessary care for patients while protecting them and their clinicians from undue risk of exposure to COVID-19. This multiphase, Veteran-centered approach to developing and evaluating a novel behavioral intervention to provide full cost transparency to Veterans will achieve the following aims: Aim 1: Create an automated system to generate personalized estimates of Veterans' full costs (travel costs, time costs, and out-of-pocket costs) for different types of primary care visits. Aim 2: Develop and refine a novel behavioral intervention that will help Veterans and their clinicians use personalized information about the full costs of different types of primary care visits in the VHA. Aim 3: Evaluate the acceptability, feasibility, and preliminary effectiveness of the developed intervention to Veterans and their clinicians.
This study is investigating the self-report adherence and assessment completion rates when presented with a transdiagnostic, partial assessment multiple times a day when compared with a monotopic, complete assessment once a day. Specifically, the investigators are testing the hypothesis that the personalization of diagnostic assessment topics and timing will lead to improved self-report regiment adherence rates, assessment completion rates, and total assessments completed during the study period. The study does not test the efficacy of the personalized assessments as a diagnostic instrument, there is no clinical decision support provided to clinicians during this study, and there is no treatment provided during this study.