Clinical Trials Logo

Clinical Trial Summary

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.

Clinical Trial Description

Within VA Primary Care, the COVID-19 pandemic has resulted in an abrupt shift from mostly face-to-face visits to almost exclusively telephone and VA Video Connect (VVC) appointments. As the COVID-19 curve has flattened and personal protective equipment (PPE) supplies have stabilized, VA Medical Centers such as the VA Ann Arbor Healthcare System are now grappling with how to match these opportunities for different vehicles for delivering ambulatory care to patients' needs and preferences. One highly promising, Veteran-centered way to match opportunities for face-to-face, telephone, and VVC visits in the COVID-19 era is to consider the value each visit type yields for an individual Veteran. Value for a given health care service is broadly defined as its health outcomes (i.e., benefits) per dollars spent (i.e., costs). From the perspective of patients, costs entail not just out-of-pocket (OOP) expenses but also travel and time costs. These costs are even more salient for many Veterans in the current economic downturn which, unfortunately, is unlikely to abate until the US fully emerges from the COVID-19 pandemic. Careful consideration of these full costs -- which can vary widely across face-to-face, telephone, and VVC visits -- by both Veterans and their clinicians could result in higher-value ambulatory care visits. For example, when services could be provided by telephone rather than a face-to-face visit, the former would result in much higher value for Veterans because there are no copays or travel costs for telephone visits. Similarly, when a face-to-face visit is necessary, transparent cost information could encourage Veterans and their clinicians to maximize the necessary services delivered, amplifying the benefits realized for the relatively higher patient cost of that particular type of visit. Despite the clear benefits of making patient costs more transparent, and of broader policy initiatives within VA to better inform Veterans' health care choices, Veterans and their clinicians currently lack the personalized cost information that they need to make high-value choices about ambulatory visit modalities. This project will make transparent the full costs to Veterans of different types of ambulatory visits in order to optimize the value of their health care investments in the COVID-19 era and beyond. ;

Study Design

Related Conditions & MeSH terms

NCT number NCT05026684
Study type Interventional
Source VA Ann Arbor Healthcare System
Contact Jeffrey T. Kullgren, MD, MS, MPH
Phone (734) 845-3502
Email [email protected]
Status Recruiting
Phase N/A
Start date July 15, 2021
Completion date June 30, 2022

See also
  Status Clinical Trial Phase
Completed NCT04594967 - The COPACC Study: Utilization, Health and Economic Evaluation of a Community-Based Primary Care Geriatric Hub at Whampoa
Enrolling by invitation NCT01004276 - Increasing Smoking Cessation Counselling in Primary Care Using a Chronic Disease Management System N/A
Recruiting NCT03946319 - Personalized, Transdiagnostic Approach to Preventative Mental Health N/A
Completed NCT01139398 - Effect of Limicol on (LDL)-Cholesterol Levels in Moderate Hypercholesterolaemia N/A
Active, not recruiting NCT03862261 - Integrating Pediatric TB Services Into Child Healthcare Services in Africa N/A
Completed NCT00119548 - Improving HIV Screening With Nurse-Based Rapid Testing/Streamlined Counseling N/A
Active, not recruiting NCT03459664 - Evaluation of a Cross-sectional Coordinated, Severity Stepped, Evidence-based Care Model for Mental Disorders N/A
Completed NCT01137305 - Soft Skills and Surgical Performance N/A
Withdrawn NCT03202745 - The Effect of Informative Letters on the Prescription and Receipt of Opioids N/A
Completed NCT01304108 - Improving Venous Thromboembolism Prophylaxis Phase 4
Completed NCT02625142 - Family-Centered Rounds Checklist Implementation N/A
Completed NCT02665429 - A Quality Improvement Project to Investigate Individual Provider Variation in Opioid Prescribing From the Emergency Department N/A
Completed NCT04176146 - Nudging Healthcare Organizations to Adopt New Care Delivery Practices N/A
Completed NCT04722289 - The Together on Diabetes Intervention - a Realist Evaluation N/A
Enrolling by invitation NCT03715907 - Financial Incentives for Care Gaps N/A
Completed NCT02345434 - The Effect of Informative Letters on the Prescription and Receipt of Schedule II Controlled Substances N/A
Completed NCT02467933 - The Effect of Informative Letters on the Prescription and Receipt of Seroquel N/A