Chronic Illness
Conditions
Keywords
Health Records, Personal, Delivery of healthcare, Consumer Participation, Internet
Brief summary
This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Department of Veteran's Affairs' (VA) personal health record, My HealtheVet (MHV). Participants will be randomized to receive either training on 1) how to use My HealtheVet to share VA health information or 2) training on how to how to search the Internet for health information and decide which Internet sites have good quality information. The investigators predict that Veterans who receive the My HealtheVet training will have fewer medication errors and duplication of services between the VA and outside providers.
Detailed description
This study aims to conduct a pilot of an intervention to improve care coordination between VA and non-VA providers using the Department of Veteran's Affairs' (VA) personal health record, My HealtheVet (MHV). Background: The Blue Button feature of My HealtheVet allows Veterans to print out a comprehensive summary of their health that can be shared with non-VA providers. Dual use is common and has been associated with negative health outcomes including higher mortality. Preliminary data collected by the principal investigator in collaboration with the My HealtheVet Performance Evaluation workgroup shows that few Veterans enrolled in My HealtheVet use it to inform either VA or non-VA providers of their care. To remedy this, the principal investigator has developed an online video and companion paper-based training. This training will teach Veterans how to use the Blue Button feature and why it is important to share the print out with their non-VA provider. Methods: To participate, Veterans must have an upcoming non-VA provider appointment, be prescribed 5 or more medications, and be registered on My HealtheVet with a premium account. Participants will be randomized to receive either training on how to use the Blue Button or training on how to search for health information on the Internet and if that information is good quality. Veterans in both arms will receive training materials and phone support. After the non-VA provider visit, both the Veteran and the provider will be asked to indicate what occurred during the visit, including whether or not the Veteran gave the provider the Blue Button print out. Both Veterans and providers will also be asked to complete a 15-minute qualitative interview about their experience during the visit. Medical records of the non-VA provider visit will be obtained. Outcomes: The main outcome for the study is whether the patient provided the non-VA provider a copy of his or her health information printed from My HealtheVet. In addition, comparison between the VA and non-VA provider records will be conducted to test whether Veterans who completed the training had 1) better medication reconciliation between the VA and the non-VA provider and 2) fewer instances of therapeutic or laboratory duplication. The results of this pilot will be used to inform a larger randomized controlled trial of the training intervention.
Interventions
BEHAVIORALMy HealtheVet Training
Participants will be asked to watch an on-line training video, review written materials, and print a document containing health information from their My HealtheVet account.
OTHERInternet Skills Training
Participants will review written training materials to learn how to search the Internet for health information and how to decide which Internet sites have good quality information.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Upcoming Non-VA provider appointment * Take 5 or more prescribed medications * Have or obtain a My HealtheVet premium account * Access to computer, printer, & Internet to complete study protocol
Exclusion criteria
* No non-VA provider or upcoming appointment * Less than 5 medications * No premium MHV account
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Brought Their VA Information From My HealtheVet to Their Visit With Their Non-VA Provider | Within 1-2 week of non-VA provider visit | The primary outcome is whether or not the veteran brings their VA information from My HealtheVet to their visit with their non-VA provider. Providers will be asked to complete a form during the appointment where assessment of sharing this information is embedded in a checklist of possible visit activities. Participants will also if they provided this information to the provider in the event the provider opts to not return the form. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Total Number of Unique Medications Discrepant Between VA and Non-VA Medication Lists | Typically within 1 month of non-VA provider visit | A medication discrepancy metric was be calculated by comparing the current VA medication list with the non-VA provider medication list to determine the total number of distinct medications. The number of discrepant medications between these lists is the numerator and is divided by the total number of distinct medications on both lists combined. This will yield a range of scores between score between 0 and 1, with 1 indicating perfect agreement between the two lists. |
| Proportion of Participants Who Received One or More Duplicate Laboratory Tests in the Non-VA Provider Visit. | Typically within 1 month of non-VA provider visit | Therapeutic duplication will be defined as concurrent use of more than one medication from the same therapeutic class. For laboratory duplication, we will review non-VA and VA medical records 6 months prior to the non-VA provider visit. Each patient will be assigned a dichotomous indicator for whether they received therapeutic duplication and/or laboratory duplication during their non-VA provider visit |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| My HealtheVet Training Participants will be asked to watch an on-line training video, review written materials, and print a document containing health information from their My HealtheVet account.
My HealtheVet Training: Participants will be asked to watch an on-line training video, review written materials, and print a document containing health information from their My HealtheVet account. | 27 |
| Internet Skills Training Participants will review written training materials to learn how to search the Internet for health information and how to decide which Internet sites have good quality information.
Internet Skills Training: Participants will review written training materials to learn how to search the Internet for health information and how to decide which Internet sites have good quality information. | 25 |
| Total | 52 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 3 | 5 |
Baseline characteristics
| Characteristic | My HealtheVet Training | Total | Internet Skills Training |
|---|---|---|---|
| Age, Continuous | 68.4 Years STANDARD_DEVIATION 6 | 68.4 Years STANDARD_DEVIATION 6.2 | 68.5 Years STANDARD_DEVIATION 6.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 3 Participants | 3 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 26 Participants | 48 Participants | 22 Participants |
| Region of Enrollment United States | 27 participants | 52 participants | 25 participants |
| Sex: Female, Male Female | 2 Participants | 6 Participants | 4 Participants |
| Sex: Female, Male Male | 25 Participants | 46 Participants | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 27 | 0 / 25 |
| serious Total, serious adverse events | 0 / 27 | 0 / 25 |
Outcome results
Primary
Percentage of Participants Who Brought Their VA Information From My HealtheVet to Their Visit With Their Non-VA Provider
The primary outcome is whether or not the veteran brings their VA information from My HealtheVet to their visit with their non-VA provider. Providers will be asked to complete a form during the appointment where assessment of sharing this information is embedded in a checklist of possible visit activities. Participants will also if they provided this information to the provider in the event the provider opts to not return the form.
Time frame: Within 1-2 week of non-VA provider visit
Population: This outcome was collected from the provider completed questionnaire. The reduced sample size is due to the response rate for the My Healthe Vet training group providers (74%) and the Internet Skills Training group (52%).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| My HealtheVet Training | Percentage of Participants Who Brought Their VA Information From My HealtheVet to Their Visit With Their Non-VA Provider | 90 Percentage of Participants |
| Internet Skills Training | Percentage of Participants Who Brought Their VA Information From My HealtheVet to Their Visit With Their Non-VA Provider | 6 Percentage of Participants |
Comparison: This was a 2x2 comparison using Fisher's exact due to low expected cell count. Fisher's exact p\<0.001p-value: <0.001Fisher Exact
Secondary
Proportion of Participants Who Received One or More Duplicate Laboratory Tests in the Non-VA Provider Visit.
Therapeutic duplication will be defined as concurrent use of more than one medication from the same therapeutic class. For laboratory duplication, we will review non-VA and VA medical records 6 months prior to the non-VA provider visit. Each patient will be assigned a dichotomous indicator for whether they received therapeutic duplication and/or laboratory duplication during their non-VA provider visit
Time frame: Typically within 1 month of non-VA provider visit
Population: Some veterans had their laboratories drawn prior to the medical visit and were therefore excluded from this analysis.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| My HealtheVet Training | Proportion of Participants Who Received One or More Duplicate Laboratory Tests in the Non-VA Provider Visit. | 0 proportion of participants |
| Internet Skills Training | Proportion of Participants Who Received One or More Duplicate Laboratory Tests in the Non-VA Provider Visit. | 27 proportion of participants |
p-value: 0.02Fisher's Exact
Secondary
Proportion of Total Number of Unique Medications Discrepant Between VA and Non-VA Medication Lists
A medication discrepancy metric was be calculated by comparing the current VA medication list with the non-VA provider medication list to determine the total number of distinct medications. The number of discrepant medications between these lists is the numerator and is divided by the total number of distinct medications on both lists combined. This will yield a range of scores between score between 0 and 1, with 1 indicating perfect agreement between the two lists.
Time frame: Typically within 1 month of non-VA provider visit
Population: Medication reconciliation was based on Medical Record Review, therefore there was better representation of the entire sample. 2 Veterans were not included in the Internet Skills Training group because the medical records sent from the Non-VA provider were not adequate to determine an accurate medication list.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| My HealtheVet Training | Proportion of Total Number of Unique Medications Discrepant Between VA and Non-VA Medication Lists | 0.49 proportion of medications discrepant | Standard Deviation 0.25 |
| Internet Skills Training | Proportion of Total Number of Unique Medications Discrepant Between VA and Non-VA Medication Lists | 0.44 proportion of medications discrepant | Standard Deviation 0.23 |
p-value: 0.73Wilcoxon (Mann-Whitney)