Health Coach Program to Improve Chronic Disease Outcomes Following an Emergency Department Visit

Hypertension Clinical Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02386540
• Other study ID #: IRB 14-08123E
• Status: Completed
• Phase: N/A
• Start date: February 6, 2015
• Est. completion date: December 10, 2018

Study information

• Verified date: December 2018
• Source: Alameda County Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to determine whether health coaching initiated in the emergency department (ED) reduces subsequent ED visits, increases primary care visits, and positively impacts health outcomes in patients with diabetes and/or hypertension.

Description:

Patients will be recruited by health coaches from the Highland Hospital Emergency Department. Eligible patients who agree to participate will be randomized to the control and experimental groups in a 2:1 ratio respectively because experimental group size is limited by health coach availability and greater loss-to-follow up is expected among the control group. Repeated measures analysis will be used to compare each outcome over the study period. In addition, subgroup analyses will be performed in order to stratify by baseline survey measures or amount of ED visits in the pre-observation period.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 295
• Est. completion date: December 10, 2018
• Est. primary completion date: December 10, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Willing to work with a health coach

• Plans to reside in Alameda County for the next year

• Has a reliable phone number

• Speaks English or Spanish

• 18 years of age or older

• Meets at least one of the following three criteria: (1) Low medication adherence defined as a continuous medication gap of at least 1 month in the past year OR a new diagnosis of diabetes and/or hypertension; (2) No patient-identified primary care provider (PCP) or no visit to PCP in 1 year; (3) One or more visits to the ED in the last 6 months.

Exclusion Criteria:

• Life-expectancy less than 1 year

• Poorly controlled psychiatric illness

• Homeless

• Active and frequent use of illicit substances

• Currently incarcerated

• Already enrolled in a program for patients with high rates of hospitalization and/or emergency department visits

• Unable to consent due to an unstable condition or serious emotional or neurologic condition

• Admitted or anticipated to be admitted to the hospital from the ED

Related Conditions & MeSH terms

• Diabetes Mellitus
• Hypertension

Intervention

Behavioral:
• Health Coaching
The Alameda County Health Coach program pairs patients with a language-concordant health coach for six months following an ED visit. Health coaches are young adults from the local community employed through Alameda County and trained for three months in topics such as self-management support and motivational interviewing. Health coaches work one-on-one with participants in order to develop an action plan in order to achieve patient-identified health goals. Communication between the health coach and participant includes text messages (weekly), phone calls (twice a month), face-to-face visits (at least once), and accompaniment to a primary care visit (at least once). Health coaches may also assist participants in accessing community resources as related to the individualized action plan.

Locations

Country	Name	City	State
United States	Highland Hospital - Alameda Health System	Oakland	California

Sponsors (3)

Lead Sponsor	Collaborator
Alameda County Medical Center	Robert Wood Johnson Foundation, University of California, Berkeley

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of emergency department visits	Self-reported measure collected via follow-up phone surveys at 1, 3, and 6 months.	6 month period after enrollment
Secondary	Number of primary care visits	Self-reported measure collected by follow-up phone surveys at 1,3, and 6 months.	6 month period after enrollment
Secondary	Physical health and mental health (Validated measure - SF-12v2)	Validated measure (SF-12v2) collected at baseline and follow-up phone surveys.	Baseline, 1 month, 3 months, and 6 months after enrollment
Secondary	Medication adherence (Validated measure - Morisky Medication Adherence Scale, MMAS-8)	Validated measure (Morisky Medication Adherence Scale, MMAS-8) collected at baseline and follow-up phone surveys.	Baseline, 1 month, 3 months, and 6 months after enrollment
Secondary	Patient activation (Validated measure - Patient Activation Measure, PAM)	Validated measure (Patient Activation Measure, PAM) collected at baseline and follow-up phone surveys.	Baseline, 1 month, 3 months, and 6 months after enrollment
Secondary	Type and frequency of health coach contact	Health coach documentation notes will be analyzed to determine the average percent of each type of contact (text, phone, or in-person) and frequency of contact.	6 months after enrollment
Secondary	Percent of action plan goals achieved (Health coach documentation notes)	Health coach documentation notes will be analyzed to determine the percent of goals achieved during the intervention.	6 months after enrollment
Secondary	Qualitative analysis of action plans (Health coach documentation notes will be analyzed, data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan)	Health coach documentation notes will be analyzed using a grounded theory approach, where transcribed data will be coded to identify themes such as type of goals, barriers to care, and resources identified in the action plan.	6 months after enrollment

External Links

•   Please click here for more information about the Alameda County Health Coach Program (ACHCP).