Prostate Cancer Clinical Trial
Official title:
Effectiveness of Electronic Health Record-Based Interventions for Improving Follow-Up in Primary Care
Verified date | January 2016 |
Source | Baylor College of Medicine |
Contact | n/a |
Is FDA regulated | No |
Health authority | United States: Institutional Review Board |
Study type | Interventional |
Diagnostic delays in ambulatory care are often due to breakdowns of related care processes.
Electronic systems can improve follow-up and reduce delays by detecting missed appointments
or incomplete procedures so that patients are called back to conduct timely investigations
when appropriate. To achieve high standards of patient safety in cancer diagnosis, the
investigators not only need to use information technology appropriately but also improve the
processes, policies, and procedures of monitoring, communication, and coordination of care.
Given the importance of cancer-related diagnostic delays in ambulatory care, the
investigators need effective methods to detect them, understand their causes, and intervene
to reduce them. Manual techniques to detect these delays, such as spontaneous reporting and
random chart reviews, have limited effectiveness. Our proposed study focuses on testing
methods to proactively identify delays using certain "triggers" as they occur and intervene
in a timely manner.
Status | Completed |
Enrollment | 1256 |
Est. completion date | August 2012 |
Est. primary completion date | August 2012 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years to 65 Years |
Eligibility |
Inclusion Criteria: All primary care providers at both study sites who agree to be in the study. Intervention will be performed on those whose patients are electronically identified to have suspected cancer defined as presence of any predefined clue for cancer that is not followed-up in a timely manner. Three cancers are included; colorectal, lung and prostate and their clues include • chest x-imaging suspicious for malignancy • suspected or confirmed iron deficiency anemia • positive FOBT • hematochezia • abnormal PSA Patients will be selected from the data warehouse . Exclusion Criteria: Primary care providers who do not wish to be in the study. |
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Caregiver), Primary Purpose: Health Services Research
Country | Name | City | State |
---|---|---|---|
United States | Michael E. DeBakey VA Medical Center | Houston | Texas |
United States | Scott and White Memorial Hospital | Temple | Texas |
Lead Sponsor | Collaborator |
---|---|
Baylor College of Medicine | Scott and White Hospital & Clinic |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Differences in Time to Documented Follow-up of a Red Flag Suggestive of Cancer | Differences between the intervention and control groups (based on a Cox Proportional Hazards Survival Analysis) in median time to documented follow-up of a red flag (e.g., colonoscopy performance after positive FOBT) or of a deliberate decision by the treating provider not to take follow-up action. When less than 50% of patients in either group received diagnostic evaluation (ie, medians were not reached), the point at which 40% received diagnostic evaluation was compared instead. | 15 months | Yes |
Secondary | Percentage of Patients Receiving Timely Follow-up of a Red Flag Suggestive of Cancer | The percentage of patients receiving timely follow-up care, as defined by action taken by provider within appropriate pre-defined time intervals for each diagnostic clue, in both intervention and control groups. | 15 months | Yes |
Secondary | Percentage of Cases With no Documented Justification for no Follow-up | This is a descriptive sub-analysis looking only at cases with no follow-up at the end of the follow-up period. Specifically, out of the cases that never got follow-up, this represents the percent of that subsample that had no justification in the medical record for the lack of follow-up. This is based on manual chart reviews. | 15 months | Yes |
Secondary | Number of Participants Diagnosed With Cancer After Delay in Diagnostic Evaluation | Subsequent diagnosis of nonmalignant neoplasia, cancer, or death, and treatments required as a result of new cancer diagnoses after a pre-specified interval. | 15 months | Yes |
Secondary | Trigger Positive Predictive Value | Positive Predictive Values of each of the triggers in identifying patients with a true delay in diagnostic evaluation. Calculated as: percentage of patients identified as trigger positive that actually had a delay. | 15 months | Yes |
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