Primary Care
Conditions
Brief summary
The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare.
Detailed description
The proposed research will provide important insight into two serious problems for veterans' healthcare: 1) mixed effectiveness of communication improvement interventions in the VA to date, and 2) persistence of racial/ethnic disparities in VA healthcare. We have identified 4 best acts of physician communication that patients believe to be most important in a clinical interaction. We propose to develop and evaluate a physician communication intervention that focuses specifically on these acts. In addition, our abundance of pilot study data from patients of various races/ethnicities enables us to create an intervention applicable to communication that spans patient race/ethnicity. Evaluating this intervention with physicians and patients in 2 independent VA primary care settings will help determine whether a patient-driven communication focus that incorporates input from patients of varied race/ethnicity can help close the gap in health outcomes between white and minority veterans. We aim to (1) demonstrate the efficacy of using best acts of physician communication as content for an intervention to improve physician communication skills overall and reduce variation in communication with white versus racial/ethnic minority patients, and (2) assess the impact of patient experiences of best acts on patients' perceptual and behavioral outcomes. We have collected data from over 200 primary care patients as they viewed a video of themselves and their physician interacting during a clinic visit. From these data, we are developing an educational intervention for physicians that focuses specifically on the 4 best acts we have identified. Scripts of the 4 best acts will be developed, and standardized patients at Baylor College of Medicine will perform the acts, which will be video recorded. We will then conduct a 2-site longitudinal observational study of 16 primary care physicians (8 at each site) and 36 patients of each physician. At the first site at 3-month intervals, physicians will attend an instruction session consisting of viewing a video of one best act and participating in group discussion, role-playing re-enactment of the act, and formulation of bulleted take-away points to facilitate subsequent recall. Once completed, the sequence of sessions will occur at the second site. At both sites, clinical interactions of participating physicians and patients will be audio recorded, and audio recordings will be analyzed for frequency of occurrence of the 4 best acts. After each study visit, each patient will complete validated surveys measuring patients' perceptions of their physician on 4 affective dimensions known to impact patients' subsequent perceptual and behavioral outcomes. Efficacy will be assessed across patient demographics.
Interventions
BEHAVIORALProvider Communication Skills Training
Consists of 4 separate 1-hour sessions, 1 per best act, in which physicians view 3 video-recorded performances of each act performed by trained actors of varied race/ethnicity.
Sponsors
US Department of Veterans Affairs
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Any patient included in the regular panel of a participating physician at either study site who is a returning patient for that physician. Since 2 of the patient perceptual measures included require the pre-existence of a relationship with a specific physician, we will only enroll patients who have been seen by their physician before.
Exclusion criteria
* Physical disabilities that prohibit unassisted participation in research protocol: * legal blindness * dementia * severe post-traumatic stress disorder * schizophrenic disorder * Alzheimer's disease * bipolar disorder * and severe anxiety and/or mood disorders (must be documented in patient's medical record or attested to by patient, physician or charge nurse). * Also, no patients new to VA primary care or to a given participating physician will be enrolled.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Provider Use of Best Acts From Baseline to Post-Intervention | Baseline, 18 months | Mean per-patient use of best acts learned during provider communication skills intervention, post-intervention minus baseline. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Provider Communication Skills Training Consists of 4 separate 1-hour sessions, 1 per best act, in which physicians view 3 video-recorded performances of each act performed by trained actors of varied race/ethnicity. | 369 |
| Total | 369 |
Baseline characteristics
| Characteristic | Provider Communication Skills Training |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 114 Participants |
| Age, Categorical Between 18 and 65 years | 255 Participants |
| Race/Ethnicity, Customized Black/African American | 207 participants |
| Race/Ethnicity, Customized Hispanic/Latino | 30 participants |
| Race/Ethnicity, Customized Other Race/Ethnicity | 3 participants |
| Race/Ethnicity, Customized White | 129 participants |
| Sex: Female, Male Female | 31 Participants |
| Sex: Female, Male Male | 338 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Change in Provider Use of Best Acts From Baseline to Post-Intervention
Mean per-patient use of best acts learned during provider communication skills intervention, post-intervention minus baseline.
Time frame: Baseline, 18 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm 1 | Change in Provider Use of Best Acts From Baseline to Post-Intervention | 0.3 best acts per patient | Standard Deviation 0.7 |
Comparison: Increase in mean, post-intervention versus baseline, across 18 providers and 369 patients.p-value: 0.03t-test, 1 sided