Hypertension Clinical Trial
— TRACCOfficial title:
Cohort Study to Investigate the Outcomes of Patients With Hypertension and/or Diabetes Mellitus and the Effectiveness and Cost-effectiveness of Structured Multi-disciplinary Intervention Programmes
NCT number | NCT04302974 |
Other study ID # | UW19-329 |
Secondary ID | |
Status | Recruiting |
Phase | |
First received | |
Last updated | |
Start date | August 1, 2019 |
Est. completion date | June 2024 |
Objectives: To determine the outcome trajectories of patients with hypertension (HT) and/or diabetes mellitus (DM), and evaluate the long-term effectiveness and cost-effectiveness of the Risk Assessment and Management Programmes (RAMP) and other primary care services such as Patient Support Call Centre (PSCC) on reducing complications and mortality Design: Population-based cohort study Setting: Hospital Authority (HA) primary care clinics Participants: All patients aged ≥18 years with DM or HT managed in HA primary care clinics between 2006 and 2021 Main outcome measures: (1) incidence of DM/HT-related complications (cardiovascular disease, end-stage renal disease, retinopathy, neuropathy and all-cause mortality); (2) service utilization (out-patient clinics, Accident and Emergency and overnight hospitalizations); (3) Incremental cost-effectiveness ratio per complications or all-cause death avoided, and per QALY gained by RAMP or PSCC. Methods: A naturalistic cohort study (maximum 10-year follow-up) and retrospective data extraction from the HA clinical management system (CMS) database will be conducted to identify and correlate outcome trajectories of HT and/or DM patients with personal, service delivery and process of care factors. Outcomes of propensity score matched cohorts who have and have not participated in the programmes will be compared. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be conducted to evaluate the effect of RAMP, PSCC and other primary care services on the risk of complications, mortality and service utilization. Empirical costs and effectiveness data will be used to calculate cost-effectiveness from the provider's perspective. Significance: Findings will inform how to optimize service delivery for HT/DM patients in Hong Kong
Status | Recruiting |
Enrollment | 59286 |
Est. completion date | June 2024 |
Est. primary completion date | June 2023 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: (Trajectory study) - All patients aged 18 years or above with a documented doctor-diagnosed DM or HT between 2006 and 2019. - Documented management in the HA GOPC or FMC identified from the HA CM database between 2006 and 2019. (10-year CEA study on RAMP-DM) - Documented diagnosis of DM without any known complications on or before September 2010 - Documented management in the HA GOPC and FMC identified from the HA CMS database between 2009 and 2019, - Patients who attended the first RAMP-DM assessment between August 2009 to September 2010 for inclusion in the RAMP-DM cohort - Patients who have never attended any RAMP-DM assessment between August 2009 to December 2019 for inclusion in the usual care only cohort (10-year CEA study on RAMP-HT) - Documented diagnosis of HT without DM and any known complications on or before March 2013 - Documented management in the HA GOPC and FMC identified from the HA CMS database between 2011 and 2021, - Patients who attended the first RAMP-HT assessment between October 2011 to March 2013 for inclusion in the RAMP-HT cohort - Patients who have never attended any RAMP-HT assessment between October 2011 to December 2021 for inclusion in the usual care only cohort (5-year CEA study on PSCC) - Documented diagnosis of DM without any known complications on or before August 2016 - Documented management in the HA GOPC and FMC identified from the HA CMS database between 2012 and 2021, - Patients who attended the first RAMP-DM assessment between September 2012 to August 2016 - Patients who received the first PSCC call between September 2012 to August 2016 after the first RAMP-DM assessment for inclusion in the PSCC cohort - Patients who have never received any PSCC services between September 2012 to December 2021 for inclusion in the RAMP only cohort Exclusion Criteria: (applicable to all sub-studies) - Non-Chinese - Patients with documented DM/HT-related complications diagnosed before the date of enrolment - Medical specialist outpatient attendance before or within the first year of inclusion to study, to exclude subjects who might have developed complications before study enrolment |
Country | Name | City | State |
---|---|---|---|
China | Department of Family Medicine & Primary Care, LKS Faculty of Medicine, University of Hong Kong | Hong Kong | Hong Kong |
Lead Sponsor | Collaborator |
---|---|
The University of Hong Kong |
China,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Incidence of DM/HT-related complications (cardiovascular disease, end-stage renal disease, retinopathy, neuropathy and all-cause mortality) | The disease are defined by the diagnosis codes International Classification of Primary Care, Second edition or International Classification of Diseases,Ninth Revision, Clinical Modification. | 10 years | |
Primary | Service utilization rate (out-patient clinics, Accident and Emergency and hospitalizations) | Based on the electronic health record from Hong Kong Hospital Authority | 10 years | |
Primary | Incremental cost-effectiveness ratio per DM/HT-related complication or all-cause death avoided, and per QALY gained by RAMP or PSCC | The incremental cost-effectiveness ratio (ICER), that is the ratio of the incremental costs of the RAMP group over the incremental effectiveness, will be calculated for each complication event, or death avoided, and per QALY gain. | 10 years |
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