Endocrinology Auto-Triggered e-Consults

Diabetes Mellitus Clinical Trial

Official title:

Impact of Endocrinology Auto-triggered E-consults on Glycemic Control

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03542084
• Other study ID #: 2018P000683
• Status: Completed
• Phase: N/A
• Start date: September 4, 2018
• Est. completion date: August 30, 2020

Study information

• Verified date: September 2020
• Source: Massachusetts General Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Diabetes currently affects 25.8 million people in the U.S. Patients with diabetes are generally managed, at least initially, by a primary care practitioner (PCP). As the prevalence of diabetes continues to rise, PCPs are under increased pressure to achieve recommended glycemic targets. Failure to achieve these targets has been shown to increase clinical complications and cost of care.

Endocrinology referral is common for those patients not meeting A1c goals. Unfortunately, access to specialty endocrinology care is limited and patients routinely wait weeks or months before being seen. Electronic consultation (e-consult) is a new and innovative delivery model that has the potential to provide greater access to specialty care. The current system at Massachusetts General Hospital (MGH) allows PCPs to electively place an e-consult to solicit specialist input. Specialists in turn review the patients chart, relevant data and the clinical question and respond within the electronic medical record. E-consults have been well received by both patients and physicians, not only at MGH, but also across many centers in the US. With that said, the e-consult system remains in its infancy and current literature largely focuses on process metrics without hard clinical end-points.

One way to optimize care for patients with diabetes is to automatically trigger an endocrinology e-consult for those not meeting A1c targets. The goal of this project will be to conduct a rigorous scientific evaluation of auto-triggered e-consults across Massachusetts General Hospitals affiliated primary care practices. The e-consults will be unsolicited and triggered based on inclusion criteria that include a1c and date of last PCP visit. This project will leverage an existing diabetes population health registry that is being used currently for ongoing diabetes care initiatives.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 305
• Est. completion date: August 30, 2020
• Est. primary completion date: May 30, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Diabetic patients with a PCP at Massachusetts General Hospital and HbA1c between 8-10 who have seen their PCP in the office within 18 months

Exclusion Criteria:

• Terminal Illness

• Prior visit with MGH diabetes center

• Prior diabetes e-consult completed

Related Conditions & MeSH terms

• Diabetes Mellitus

Intervention

Other:
• Unsolicited endocrine e-consult
The PCP for intervention arm patients will receive an unsolicited e-consult from an endocrinologist with recommendations on how to improve glycemic control in the intervention patient

Locations

Country	Name	City	State
United States	Massachusetts General Hospital	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Massachusetts General Hospital

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Glycemic Control	Mean change in HbA1c levels in the patient population	6, 12, and 18 months
Secondary	Adoption of e-consult recommendations	Process measures of adoption of the recommendations provided by the e-consultant	6, 12, and 18 months
Secondary	A1c testing frequency	number of patients who receive q6 month HbA1c testing in the study population	6,12, and 18 months