Evaluation of A Coaching by Telephone Intervention for Veteran and - - PowerPoint PPT Presentation

▶
evaluation of a coaching by telephone
SMART_READER_LITE
LIVE PREVIEW

Evaluation of A Coaching by Telephone Intervention for Veteran and - - PowerPoint PPT Presentation

Oct 21, 2022 269 likes •502 views

VA Ann Arbor Center for Clinical Management Research Evaluation of A Coaching by Telephone Intervention for Veteran and Care Team Engagement Laura J. Damschroder, MS, MPH AcademyHealth Annual Research Meeting April 26, 2017 1 Background

slide-1
SLIDE 1

Evaluation of A Coaching by Telephone Intervention for Veteran and Care Team Engagement

Laura J. Damschroder, MS, MPH AcademyHealth Annual Research Meeting April 26, 2017

VA Ann Arbor Center for Clinical Management Research

slide-2
SLIDE 2

VA Ann Arbor Center for Clinical Management Research

Background

  • Over half of all deaths can be attributable to four

modifiable risk factors: tobacco use, obesity, physical inactivity and alcohol use

  • VHA has done well at addressing quality of care in chronic

illness, but less well in addressing modifiable risk factors

  • Recent strategic changes in VHA have placed more

emphasis on prevention including roll out of a web-based

Health Risk Assessment

1

Patel, Ann Intern Med, 2016

slide-3
SLIDE 3

VA Ann Arbor Center for Clinical Management Research

ACTIVATE Goals

  • To determine whether Health Risk Assessment (HRA) and

Telephone Coaching improves enrollment of Veterans in structured prevention programs compared to HRA alone

  • To determine whether HRA and Telephone Coaching improves

patient activation and cardiovascular risk compared to HRA alone

2

slide-4
SLIDE 4

VA Ann Arbor Center for Clinical Management Research

ACTIVATE

3

Design: Type 1 Hybrid RCT Study Arms: HRA + telephone coach vs. HRA alone Setting: Durham and Greenville, NC; Ann Arbor MI Subject Pool: Enrolled in Primary Care Inclusion Criteria:

  • BMI>30
  • Current Smoker
  • < 150 minutes of moderate/vigorous activity

Exclusion Criteria: Dementia, active psychosis, impaired hearing, unable to speak English, terminal illness, no access to a phone, actively enrolled in a structured prevention program in past 6 months

Contemp Clin Trials, 2017

slide-5
SLIDE 5

VA Ann Arbor Center for Clinical Management Research

Theoretical Framework for Patient Change

HRA + Health Coaching

HRA Coaching Coaching Primary Outcome Co-primary Outcome

slide-6
SLIDE 6

HRA A Coaching by Telephone Intervention for Veterans and Care Team Engagement https://www.myhealth.va.gov/

All participants

slide-7
SLIDE 7

HLA Report HRA

Review HRA Results Explore Preferences & Values Prioritize Prevention Topics Set Prevention Goal  Enroll in Program Assess Readiness & Confidence

Prevention Coach Participant

F/W Phone Call for Reinforcement

.

EMR Note with Prevention Action Plan F/U Letter with Prevention Action Plan

Intervention participants

slide-8
SLIDE 8

ACTIVATE Consort Enrollment Only

Recruitment Refused (N=813) Not Contacted (N=1216)a Ineligible (N = 423) Telephone Screened Eligible (N = 555) Randomized (N = 417)

Foot Note: a- patients were unable to complete recruitment process due to phone outages, not showing for appointment, non-responders to phone calls. b – includes formal and informal withdrawal prior to randomization as well as exclusion for failure to adhere to study protocol prior to randomization. c – includes formal and informal withdrawal post randomization. Recruitment Letter Sent N= 3007

Excluded prior randomization (N =19)b Intervention N = 208 Usual Care N =209 Consented (N = 436) Baseline Refused (N = 26) No Show (N = 90)a Ineligible (N=3)

1 month Completed (N = 172 ) 6 month Completed (N = 199 ) ____________________ Dropouts (N =9 )c No Longer Eligible (N = 1) 6 month Completed (N = 177 ) ____________________ Dropouts (N = 27)c No Longer Eligible (N = 4) 1 month Completed (N = 192 )

slide-9
SLIDE 9

VA Ann Arbor Center for Clinical Management Research

ACTIVATE – Baseline Cohort

Baseline Characteristics Intervention (n=208) Usual Care (n=209)

Actual Age, Mean (SD) 55.3 (12.7) 56.3 (11.7) HRA Health Age, Mean (SD) 60 (12.9) 60.7 (12.4) HRA Health Age minus Actual Age, Mean (SD) 4.7 (5.6) 4.4 (5.9) Male 83% 88% Race Black or African American 43% 38% White 48% 53% Married/Living as married 46% 56% Employed full/part-time 38% 35% 8

slide-10
SLIDE 10

VA Ann Arbor Center for Clinical Management Research

ACTIVATE Inclusion Criteria

Inclusion Criteria Intervention (n=208) Usual Care (n=209)

BMI>=30 77% 82% Physical Activity<150 minutes/week 48% 53% Current smoker of cigarettes 42% 40% Total # of Inclusion Criteria met 1 42% 41% 2 48% 47% 3 10% 12% 9

slide-11
SLIDE 11

VA Ann Arbor Center for Clinical Management Research

Activate--Analysis

  • Patient Unit of Randomization and Analysis
  • Primary Outcome:

– Enrollment in Structured Prevention Program (1 and 6 months)

  • Secondary Outcomes:

– Patient Activation Measure: PAM-13 Score (1 and 6 months) – Framingham Risk Score (6 months)

  • Logistic Regression to estimate treatment difference in

enrollment

  • General Linear Models with parameters of time and group

by time interaction to estimate treatment group differences in PAM and FRS

slide-12
SLIDE 12

VA Ann Arbor Center for Clinical Management Research

Adherence to Telephone Coaching

Intervention Participants (n=208)

  • 93% of participants completed Call #1
  • 88% of participants completed Call #2
  • 14 participants (7%) received neither call
slide-13
SLIDE 13

VA Ann Arbor Center for Clinical Management Research

ACTIVATE Results Enrolled and Participated in Prevention Program

Outcome Odds Ratio (95% CI) Intervention vs Usual Care P value

Ever Enrolled 0.51 (0.43, 0.58) 0.29 (0.23, 0.36) 2.54 (1.66, 3.89) <.0001 Ever Participated 0.40 (0.33, 0.48) 0.23 (0.17, 0.29) 2.28 (1.45, 3.59) 0.0004

12

slide-14
SLIDE 14

VA Ann Arbor Center for Clinical Management Research

P value

PAM Baseline 61.5 (60.3, 62.7) 61.5 (60.3, 62.7) One Month 63.2 (61.5, 64.9) 61.8 (60.1, 63.4) 1.5 (-0.8, 3.7) 0.20 Six Months 66.3 (64.6, 68.1) 63.9 (62.2, 65.5) 2.5 ( 0.2, 4.7) 0.03 Framingham Baseline 22.3 (20.7, 24.0) 22.3 (20.7, 24.0) Six Months 22.7 (20.8, 24.5) 21.9 (20.1, 23.7) 0.7 (-0.7, 2.2) 0.33

13

ACTIVATE Results Secondary Outcomes (PAM) & (FRS)

slide-15
SLIDE 15

VA Ann Arbor Center for Clinical Management Research

Prevention Program Chosen by Intervention Participants

Total VA Program Non VA Program Diet/Weight Loss 51% 41% 10% Exercise 27% 3% 24% Smoking Cessation 19% 11% 9% Other Program 3% 3% Total 100% 55% 45%

14

slide-16
SLIDE 16

VA Ann Arbor Center for Clinical Management Research

Prevention Program Chosen by Intervention Participants

Total VA Program Non VA Program Diet/Weight Loss 51% 41% 10% Exercise 27% 3% 24% Smoking Cessation 19% 11% 9% Other Program 3% 3% Total 100% 55% 45%

15

slide-17
SLIDE 17

VA Ann Arbor Center for Clinical Management Research

Limitations

  • Primary Outcome was obtained by patient self report

– Validation of VA’s MOVE! program enrollment

  • 27 of 47 patients (81%) who reported enrollment showed

EMR evidence of participation

  • 9 of 324 patients (2%) who did not report enrollment

showed EMR evidence of participation

  • Kappa=.78
  • Prior research shows that 10% of MOVE! referrals enroll

– No way to determine non-VA program participation (45% of intervention patients)

16 Kahwati, TBM, 2011

slide-18
SLIDE 18

VA Ann Arbor Center for Clinical Management Research

Conclusions

  • HRA results followed by telephone coaching:

– Improves patient activation – Facilitates Veterans enrollment and participation in structured prevention programs to address health behaviors and health risks …compared to HRA alone

  • Despite higher enrollment and participation CVD risk did not

improve by 6-months

17

slide-19
SLIDE 19

VA Ann Arbor Center for Clinical Management Research

Impact and the road ahead

  • Impact

– This study helped inform the VHA’s roll out of the HRA.

  • Challenges

– Connectivity with primary care

  • Next Steps
slide-20
SLIDE 20

Study Team and Partners

Study Team NCP Partners

Eugene Z. Oddone, M.D., M.H.Sc. Jane Kim, MD, MPH Laura J. Damschroder, MPH, MS Michael Goldstein, MD Jennifer Gierisch, PhD Peg Dundon, PhD Maren Olsen, PhD Linda Kinsinger, MD, MPH Linda Sanders, MPH Kathleen Pitman, RN, MPH Angela Fagerlin, PhD Heidi Martin Jordan Sparks, MPH Felicia McCant, MSSW Carrie Mae, MPH Marsha Turner, MPH David Currie, MPH 19

slide-21
SLIDE 21

VA Ann Arbor Center for Clinical Management Research

HLA Report HRA A Coaching by Telephone Intervention for Veterans and Care Team Engagement

Review HRA Results Explore Preferences & Values Prioritize Prevention Topics Set Prevention Goal  Enroll in Program Assess Readiness & Confidence

Prevention Coach Participant

F/W Phone Call for Reinforcement

.

EMR Note with Prevention Action Plan F/U Letter with Prevention Action Plan

Intervention participants

PACT Team Activated for Prevention

slide-22
SLIDE 22

VA Ann Arbor Center for Clinical Management Research

ACTIVATE-- Baseline Measures

Baseline Common Measures Intervention Mean (SD) Usual Care Mean (SD)

Self Rated Health (Good, Very Good, Excellent) 68% 70% PHQ8 Total Score (Range 0-24, 0=No Depression) 6.8 (5.4) 7.4 (5.5) MOS-6 Sleep Scale Score (0-100, Higher is better) 61.2 (21.3) 60.8 (22.2) Overall pain in past week (0-10, 0= No pain) 4.4 (2.7) 4.7 (2.7) Past 30 days, how many days pain disrupted usual activities 10 (11.3) 11 (11.2) 21