Behavioral Health, Cardiovascular Disease, Chronic Disease, Diabetes Mellitus Type 2, Mental Health, Substance-related Disorders, Vascular Diseases
Conditions
Keywords
Chronic disease, Mental Health, Behavioral Health, Community mental health centers, Intervention studies, Mixed methods, Qualitative research
Brief summary
Adults with serious mental illness (SMI) frequently have unmet medical needs which place them at risk for adverse health outcomes. While there are proven ways to manage and/or prevent serious medical conditions common among this population, information is needed to understand their impact on outcomes that matter most for patients, particularly in community mental health centers (CMHCs) where most adults with SMI receive their care and rural areas where locating and receiving health care services can be challenging. The investigators will test two promising ways for promoting the health, wellness, and recovery of adults with SMI. One way will help patients manage their health and health care through self-management strategies, including the use of a web portal, and peer support (patient self-directed care) and the other through interactions with nurses during clinic visits (provider-supported integrated care). The investigators will compare the two interventions on three primary patient-centered outcomes (i.e. patient activation in care, health status, engagement in primary/specialty care). The investigators hypothesize that: 1. Patient self-directed care will result in improvement in patient activation. 2. Provider-supported integrated care will result in greater improvement in frequency in primary/specialty care visits. 3. Both interventions will result in significant improvements in the three primary outcomes. The investigators will collect information from patients, caregivers, and clinic staff at different points in time during the study. Patients will be asked to complete questionnaires and additional data on their service use will be gathered. Some patients and providers will also be interviewed about their experiences with care. The investigators will examine these data to learn if, how, and why the new services improve outcomes over time. This information will help us understand patient and other stakeholder views about the services and, if appropriate, ensure their continued and/or expanded availability.
Detailed description
The combination of high medical need with difficulty accessing quality medical care makes adults with serious mental illness (SMI) one of our nation's most medically vulnerable populations. While evidence-based interventions exist for managing and/or preventing high rates of chronic medical conditions in this population, information is needed to understand their impact on outcomes that matter most for patients, particularly in community mental health centers (CMHCs) where most adults with SMI receive their care and rural areas where availability of and access to health care services is limited. Building on the work of a multi-stakeholder collaboration in rural Pennsylvania, the UPMC Center for High-Value Health Care and our patient, provider, and payer partners will evaluate two promising interventions-patient self-directed care and provider-supported integrated care-for promoting the health, wellness, and recovery of adults with SMI. We will address four questions that patients have identified as important to them: 1. Given my mental and physical conditions, what should I expect will happen to my overall health, wellness, and recovery when I engage in the new services offered by my CMHC? 2. If I choose to participate in these services, what are the potential advantages or disadvantages to me? 3. In what ways can I become more active in managing my own health and health care? 4. Which of the services that my CMHC could make available to me will impact outcomes that I care about and help me make the best decisions about my health and care? Our aims compare the effectiveness of the interventions on patient-centered outcomes and explore the moderating role of patient characteristics and the mediating role of engagement in the interventions. By demonstrating which interventions improve outcomes for whom under what circumstances, we will inform positive patient heath choices and key stakeholder decision making to support these choices, thereby advancing health system improvement efforts to avoid early mortality and comorbidity in this population. We have enrolled 1,229 Medicaid-enrolled adults who have or are at risk for chronic medical conditions and receive care at rural and suburban CMHCs. Using a cluster randomized design with a mixed-methods approach, we randomly assigned 11 CMHCs to one of the two interventions. Quantitative (self-report, claims, process) and qualitative (interviews) data will be gathered across multiple time points from baseline through the end of the two-year intervention. Descriptive and multivariate analyses will be used to examine the impact of the interventions on outcomes over time and explore the roles of moderating and mediating variables. Qualitative results will be used to understand patient and other stakeholder perspectives and promote dissemination and sustainability.
Interventions
BEHAVIORALPatient Self-Directed Care
Patient self-management toolkits, web portal with information on health conditions, personal health care use data, health tracking tools and wellness programs
BEHAVIORALProvider-Supported Integrated Care
Registered nurse on staff at community mental health centers with access to patient-level physical health information to: 1) work with patients on coordinating their care, 2) enhance communication between providers and payer, and 3) provide patient wellness support and education
Sponsors
UPMC Center for High-Value Health Care
Western Psychiatric Institute and Clinic of UPMC
Community Care Behavioral Health Organization
Columbia Montour Snyder Union Mental Health
Behavioral Health Alliance of Rural Pennsylvania
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults age 18 and older * Serious mental illness (schizophrenia, bipolar disorder, major depression) * Receive services at one of the 11 participating community mental health centers * At least one claim for outpatient case management or peer specialist services
Exclusion criteria
* Not willing to provide informed consent * Assessed by clinicians as being too ill to be treated on an outpatient basis * Unable to speak, read, or understand English at the minimum required level
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Patient Activation in Care (PAM, a 13-item Scale) | Baseline and every 6 months over 2 year active intervention period | Assessed using the PAM, a 13-item scale that renders a total activation score. This measure gauges the knowledge, skills, and confidence of patients essential to managing their own health and health care. It divides into progressively higher levels of activation: starting to take a role, building knowledge and confidences, taking action, and maintaining behaviors. The raw score scale for the PAM ranges from 13 to 52. The activation scale for the PAM ranges from 0 to 100. The lower values represent a poor outcome while higher values represent a better outcome. |
| Change in Health Status ( SF-12v2™): Physical Health Sub-scale | Baseline and every 6 months over 2 year active intervention period | Health status is measured using the SF-12v2™, a widely used and practical health survey tool consisting of 12 questions and two sub-scales for measuring physical and mental health status and symptom effects and functioning. The physical health component summary score is created using a weighted sum of all 12 items and then a scoring algorithm places negative weights on four of the health domains and positive weights on the other four health domains. Scores range from 0-100 and better physical health is indicated by a higher score. |
| Change in Engagement in Primary/Specialty Care | Updated annually using claims data over 2 year active intervention period | The frequency of primary/specialty care visits over two 12-month time periods. |
| Change in Health Status ( SF-12v2™): Mental Health Sub-scale | Baseline and every 6 months during the active intervention period | Health status is measured using the SF-12v2™, a widely used and practical health survey tool consisting of 12 questions and two sub-scales for measuring physical and mental health status and symptom effects and functioning. The mental health component summary score is created using a weighted sum of all 12 items and then a scoring algorithm places negative weights on four of the health domains and positive weights on the other four health domains (reverse of the weighting used for the physical health component summary score). Scores range from 0-100 and better mental health is indicated by a higher score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Emergent Care Use (Claims Data) | Updated annually using claims data over 2 year active intervention period | Behavioral and physical health claims data will be obtained to determine frequency of emergent service use for participants over 12-month time periods. |
| Change in Lab Monitoring - Overall | Updated annually using claims data over 2 year active intervention period | Frequency of lab tests (glucose, lipids, EKG) in 12 month periods |
| Change in Patient Satisfaction With Care | Baseline and every 6 months over 2 year active intervention period | Change in patient satisfaction with care was assessed using the Patient Assessment of Care for Chronic Conditions (PACIC). Each item of the PACIC is on a 1 to 5 scale. The total score is the average of all 20 item scores. Higher scores represent increased frequency of structured chronic care. |
| Change in Medication Adherence - Antipsychotics | Updated annually using claims data over 2 year active intervention period | Claims data used to calculate antipsychotic medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180. |
| Change in Hope (Hope Scale) | Baseline and every 6 months during the active intervention period | Assessed using the Hope Scale, an instrument designed to measure hope that has been previously used in health services research. Twelve items are rated on a four-point response scale ranging from definitely false to definitely true and summed to produce a total score. The hope scale ranges from 1 to 10, with 1 being no hope and 10 being filled with hope. |
| Change in Medication Adherence - Antidepressants | Updated annually using claims data over 2 year active intervention period | Claims data used to calculate antidepressant medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180. |
| Change in Lab Monitoring - Glucose | Updated annually using claims data over 2 year active intervention period | Frequency of glucose lab tests in 12 month periods |
| Change in Lab Monitoring - Lipids | Updated annually using claims data over 2 year active intervention period | Frequency of lipid lab tests in 12 month periods |
| Change in Lab Monitoring - EKG | Updated annually using claims data over 2 year active intervention period | Frequency of EKG tests in 12 month periods |
| Change in Medication Adherence - Hypertension | Updated annually using claims data over 2 year active intervention period | Claims data used to calculate antihypertensive medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180. |
| Change in Quality of Life (QLESQ) | Baseline and every 6 months over 2 year active intervention period | Patient quality of life is measured using the QLESQ (Quality of Life Enjoyment and Satisfaction Questionnaire) in which participants respond on a scale of 1 (very poor) to 5 (very good) their level of satisfaction with a variety of social and physical domains. The total raw score ranges from 14 to 70 or 0-100%. Only the first 14 items yield the raw total score as the last two items are standalone. The raw total score is transformed into a percentage maximum possible score using the following formula: (raw total score-minimum score)/(maximum possible raw score-minimum score). The lower values/percentages represent a poor outcome while higher values/percentages represent a better outcome. The information below reflects raw scores (rather than percentages). |
| Change in Medication Adherence - Diabetes | Updated annually using claims data over 2 year active intervention period | Claims data used to calculate diabetes medication possession ratio (MPO) for participants diagnosed with diabetes in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180. |
| Change in Functional Status (Sheehan Disability Scale) | Baseline and every 6 months over 2 year active intervention period | Functional status is measured using the Sheehan Disability Scale which assesses functional impairment in three domains including: work/school, social and family life. Respondents rate the extent to which work/school, social life and home life or family responsibilities are impaired by symptoms. The three items from the Sheehan Disability Scale are summed together into a single measure of global functional impairment. This measure ranges from 0 to 30, with 0 being unimpaired and 30 being highly impaired. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Patient Self-Directed Care See intervention description
Patient Self-Directed Care: Patient self-management toolkits, web portal with information on health conditions, personal health care use data, health tracking tools and wellness programs | 516 |
| Provider-Supported Integrated Care See intervention description
Provider-Supported Integrated Care: Registered nurse on staff at community mental health centers with access to patient-level physical health information to: 1) work with patients on coordinating their care, 2) enhance communication between providers and payer, and 3) provide patient wellness support and education | 713 |
| Total | 1,229 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 3 | 6 |
| Overall Study | Lost to Follow-up | 85 | 96 |
Baseline characteristics
| Characteristic | Total | Patient Self-Directed Care | Provider-Supported Integrated Care |
|---|---|---|---|
| Age, Continuous | 43.01 years | 42.37 years | 43.47 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 6 Participants | 2 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1223 Participants | 514 Participants | 709 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 93 Participants | 21 Participants | 72 Participants |
| Race (NIH/OMB) More than one race | 26 Participants | 11 Participants | 15 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 | 1104 Participants | 483 Participants | 621 Participants |
| Sex: Female, Male Female | 769 Participants | 341 Participants | 428 Participants |
| Sex: Female, Male Male | 460 Participants | 175 Participants | 285 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 3 / 516 | 6 / 713 |
| other Total, other adverse events | 0 / 516 | 0 / 713 |
| serious Total, serious adverse events | 3 / 516 | 6 / 713 |
Outcome results
Primary
Change in Engagement in Primary/Specialty Care
The frequency of primary/specialty care visits over two 12-month time periods.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: Study participants who were Medicaid eligible for 80% of the year prior to the data collection time point
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Engagement in Primary/Specialty Care | 24-month follow up | 11.05 Frequency of visits in 12-month periods | Standard Deviation 8.58 |
| Patient Self-Directed Care | Change in Engagement in Primary/Specialty Care | Baseline | 9.87 Frequency of visits in 12-month periods | Standard Deviation 7.93 |
| Patient Self-Directed Care | Change in Engagement in Primary/Specialty Care | 12-month follow up | 11.33 Frequency of visits in 12-month periods | Standard Deviation 8.46 |
| Provider-Supported Integrated Care | Change in Engagement in Primary/Specialty Care | 12-month follow up | 11.77 Frequency of visits in 12-month periods | Standard Deviation 7.93 |
| Provider-Supported Integrated Care | Change in Engagement in Primary/Specialty Care | Baseline | 8.72 Frequency of visits in 12-month periods | Standard Deviation 6.69 |
| Provider-Supported Integrated Care | Change in Engagement in Primary/Specialty Care | 24-month follow up | 10.88 Frequency of visits in 12-month periods | Standard Deviation 7.9 |
Comparison: Treatment by time interaction testp-value: 0.4582Mixed Models Analysis
Comparison: Test for change over time from baseline (only conducted if treatment by time interaction test non-significant)p-value: <0.0001Mixed Models Analysis
Comparison: Test for gender by treatment by time interactionp-value: 0.05Mixed Models Analysis
Comparison: Test for gender by treatment interaction (only calculated if gender by treatment by time non-significant)p-value: 0.1792Mixed Models Analysis
Primary
Change in Health Status ( SF-12v2™): Mental Health Sub-scale
Health status is measured using the SF-12v2™, a widely used and practical health survey tool consisting of 12 questions and two sub-scales for measuring physical and mental health status and symptom effects and functioning. The mental health component summary score is created using a weighted sum of all 12 items and then a scoring algorithm places negative weights on four of the health domains and positive weights on the other four health domains (reverse of the weighting used for the physical health component summary score). Scores range from 0-100 and better mental health is indicated by a higher score.
Time frame: Baseline and every 6 months during the active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 6-month follow up | 37.79 units on a scale | Standard Deviation 11.18 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 18-month follow up | 38.52 units on a scale | Standard Deviation 11.15 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | Baseline | 36.59 units on a scale | Standard Deviation 11.91 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 24-month follow up | 39.63 units on a scale | Standard Deviation 11.38 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 12-month follow up | 39.42 units on a scale | Standard Deviation 10.35 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 24-month follow up | 40.56 units on a scale | Standard Deviation 11.92 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 6-month follow up | 40.78 units on a scale | Standard Deviation 12.02 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 12-month follow up | 39.80 units on a scale | Standard Deviation 11.48 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | 18-month follow up | 40.63 units on a scale | Standard Deviation 11.4 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Mental Health Sub-scale | Baseline | 39.57 units on a scale | Standard Deviation 12.13 |
Comparison: Treatment by time interaction testp-value: 0.2179Mixed Models Analysis
Comparison: Test for change over time from baseline (only conducted if treatment by time interaction test non-significant)p-value: <0.0001Mixed Models Analysis
Comparison: Test for gender by treatment by time interactionp-value: 0.4797Mixed Models Analysis
Comparison: Test for gender by treatment interaction (only calculated if gender by treatment by time non-significant)p-value: 0.0014Mixed Models Analysis
Primary
Change in Health Status ( SF-12v2™): Physical Health Sub-scale
Health status is measured using the SF-12v2™, a widely used and practical health survey tool consisting of 12 questions and two sub-scales for measuring physical and mental health status and symptom effects and functioning. The physical health component summary score is created using a weighted sum of all 12 items and then a scoring algorithm places negative weights on four of the health domains and positive weights on the other four health domains. Scores range from 0-100 and better physical health is indicated by a higher score.
Time frame: Baseline and every 6 months over 2 year active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 6-month follow up | 41.19 units on a scale | Standard Deviation 11.44 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 18-month follow up | 39.71 units on a scale | Standard Deviation 11.8 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 12-month follow up | 41.33 units on a scale | Standard Deviation 10.78 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 24-month follow up | 40.07 units on a scale | Standard Deviation 12.16 |
| Patient Self-Directed Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | Baseline | 42.12 units on a scale | Standard Deviation 11.47 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 24-month follow up | 41.96 units on a scale | Standard Deviation 10.99 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | Baseline | 42.47 units on a scale | Standard Deviation 11.05 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 6-month follow up | 42.26 units on a scale | Standard Deviation 11 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 12-month follow up | 41.19 units on a scale | Standard Deviation 11.32 |
| Provider-Supported Integrated Care | Change in Health Status ( SF-12v2™): Physical Health Sub-scale | 18-month follow up | 41.28 units on a scale | Standard Deviation 10.99 |
Comparison: Treatment by time interaction testp-value: 0.4103Mixed Models Analysis
Comparison: Test for change over time from baseline (only conducted if treatment by time interaction test non-significant)p-value: <0.0001Mixed Models Analysis
Comparison: Test for gender by treatment by time interactionp-value: 0.4068Mixed Models Analysis
Comparison: Test for gender by treatment interaction (only calculated if gender by treatment by time non-significant)p-value: 0.2656Mixed Models Analysis
Primary
Change in Patient Activation in Care (PAM, a 13-item Scale)
Assessed using the PAM, a 13-item scale that renders a total activation score. This measure gauges the knowledge, skills, and confidence of patients essential to managing their own health and health care. It divides into progressively higher levels of activation: starting to take a role, building knowledge and confidences, taking action, and maintaining behaviors. The raw score scale for the PAM ranges from 13 to 52. The activation scale for the PAM ranges from 0 to 100. The lower values represent a poor outcome while higher values represent a better outcome.
Time frame: Baseline and every 6 months over 2 year active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 6-month follow up | 56.84 units on a scale | Standard Deviation 14.45 |
| Patient Self-Directed Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 18-month follow up | 58.90 units on a scale | Standard Deviation 14.98 |
| Patient Self-Directed Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 12-month follow up | 58.36 units on a scale | Standard Deviation 15.08 |
| Patient Self-Directed Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 24-month follow up | 57.04 units on a scale | Standard Deviation 15.15 |
| Patient Self-Directed Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | Baseline | 56.99 units on a scale | Standard Deviation 15.03 |
| Provider-Supported Integrated Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 24-month follow up | 58.61 units on a scale | Standard Deviation 15.64 |
| Provider-Supported Integrated Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | Baseline | 56.77 units on a scale | Standard Deviation 14.59 |
| Provider-Supported Integrated Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 6-month follow up | 58.74 units on a scale | Standard Deviation 14.9 |
| Provider-Supported Integrated Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 12-month follow up | 57.46 units on a scale | Standard Deviation 14.89 |
| Provider-Supported Integrated Care | Change in Patient Activation in Care (PAM, a 13-item Scale) | 18-month follow up | 57.84 units on a scale | Standard Deviation 15.11 |
Comparison: Treatment by time interaction testp-value: <0.0001Mixed Models Analysis
Comparison: Test for gender by treatment by time interactionp-value: 0.0019Mixed Models Analysis
Secondary
Change in Emergent Care Use (Claims Data)
Behavioral and physical health claims data will be obtained to determine frequency of emergent service use for participants over 12-month time periods.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: \# of individuals with 80% Medicaid eligibility in the 12 months prior to the data collection time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Emergent Care Use (Claims Data) | Baseline | 3.83 frequency of visits in 12-month periods | Standard Deviation 5.87 |
| Patient Self-Directed Care | Change in Emergent Care Use (Claims Data) | 12-month follow up | 3.21 frequency of visits in 12-month periods | Standard Deviation 5.07 |
| Patient Self-Directed Care | Change in Emergent Care Use (Claims Data) | 24-month follow-up | 2.68 frequency of visits in 12-month periods | Standard Deviation 4.44 |
| Provider-Supported Integrated Care | Change in Emergent Care Use (Claims Data) | Baseline | 2.36 frequency of visits in 12-month periods | Standard Deviation 4.32 |
| Provider-Supported Integrated Care | Change in Emergent Care Use (Claims Data) | 12-month follow up | 2.37 frequency of visits in 12-month periods | Standard Deviation 4.63 |
| Provider-Supported Integrated Care | Change in Emergent Care Use (Claims Data) | 24-month follow-up | 2.19 frequency of visits in 12-month periods | Standard Deviation 4.08 |
Comparison: Test for treatment by time interactionp-value: 0.002Mixed Models Analysis
Secondary
Change in Functional Status (Sheehan Disability Scale)
Functional status is measured using the Sheehan Disability Scale which assesses functional impairment in three domains including: work/school, social and family life. Respondents rate the extent to which work/school, social life and home life or family responsibilities are impaired by symptoms. The three items from the Sheehan Disability Scale are summed together into a single measure of global functional impairment. This measure ranges from 0 to 30, with 0 being unimpaired and 30 being highly impaired.
Time frame: Baseline and every 6 months over 2 year active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Functional Status (Sheehan Disability Scale) | 6 month follow-up | 12.97 Units on a scale | Standard Deviation 8.87 |
| Patient Self-Directed Care | Change in Functional Status (Sheehan Disability Scale) | 18 month follow-up | 13.58 Units on a scale | Standard Deviation 8.57 |
| Patient Self-Directed Care | Change in Functional Status (Sheehan Disability Scale) | 12 month follow-up | 12.71 Units on a scale | Standard Deviation 8.6 |
| Patient Self-Directed Care | Change in Functional Status (Sheehan Disability Scale) | 24 month follow-up | 13.31 Units on a scale | Standard Deviation 8.69 |
| Patient Self-Directed Care | Change in Functional Status (Sheehan Disability Scale) | Baseline | 13.82 Units on a scale | Standard Deviation 9.2 |
| Provider-Supported Integrated Care | Change in Functional Status (Sheehan Disability Scale) | 24 month follow-up | 11.90 Units on a scale | Standard Deviation 8.58 |
| Provider-Supported Integrated Care | Change in Functional Status (Sheehan Disability Scale) | Baseline | 12.71 Units on a scale | Standard Deviation 8.82 |
| Provider-Supported Integrated Care | Change in Functional Status (Sheehan Disability Scale) | 6 month follow-up | 11.33 Units on a scale | Standard Deviation 8.53 |
| Provider-Supported Integrated Care | Change in Functional Status (Sheehan Disability Scale) | 12 month follow-up | 12.29 Units on a scale | Standard Deviation 8.62 |
| Provider-Supported Integrated Care | Change in Functional Status (Sheehan Disability Scale) | 18 month follow-up | 12.20 Units on a scale | Standard Deviation 8.54 |
Comparison: Treatment by time interaction testp-value: 0.5566Mixed Models Analysis
Comparison: Test for change over time (only calculated if treatment by time interaction non-significant)p-value: <0.0001Mixed Models Analysis
Secondary
Change in Hope (Hope Scale)
Assessed using the Hope Scale, an instrument designed to measure hope that has been previously used in health services research. Twelve items are rated on a four-point response scale ranging from definitely false to definitely true and summed to produce a total score. The hope scale ranges from 1 to 10, with 1 being no hope and 10 being filled with hope.
Time frame: Baseline and every 6 months during the active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Hope (Hope Scale) | 6 month follow-up | 6.24 Units on a scale | Standard Deviation 2.52 |
| Patient Self-Directed Care | Change in Hope (Hope Scale) | 18 month follow-up | 6.31 Units on a scale | Standard Deviation 2.47 |
| Patient Self-Directed Care | Change in Hope (Hope Scale) | 12 month follow-up | 6.47 Units on a scale | Standard Deviation 2.47 |
| Patient Self-Directed Care | Change in Hope (Hope Scale) | 24 month follow-up | 6.35 Units on a scale | Standard Deviation 2.47 |
| Patient Self-Directed Care | Change in Hope (Hope Scale) | Baseline | 6.24 Units on a scale | Standard Deviation 2.59 |
| Provider-Supported Integrated Care | Change in Hope (Hope Scale) | 24 month follow-up | 6.51 Units on a scale | Standard Deviation 2.61 |
| Provider-Supported Integrated Care | Change in Hope (Hope Scale) | Baseline | 6.46 Units on a scale | Standard Deviation 2.62 |
| Provider-Supported Integrated Care | Change in Hope (Hope Scale) | 6 month follow-up | 6.57 Units on a scale | Standard Deviation 2.6 |
| Provider-Supported Integrated Care | Change in Hope (Hope Scale) | 12 month follow-up | 6.56 Units on a scale | Standard Deviation 2.64 |
| Provider-Supported Integrated Care | Change in Hope (Hope Scale) | 18 month follow-up | 6.65 Units on a scale | Standard Deviation 2.53 |
Comparison: Treatment by time interaction testp-value: 0.0058Mixed Models Analysis
Secondary
Change in Lab Monitoring - EKG
Frequency of EKG tests in 12 month periods
Time frame: Updated annually using claims data over 2 year active intervention period
Population: Study participants who were Medicaid eligible for 80% of the year prior to the data collection time point
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Lab Monitoring - EKG | Baseline | 0.12 frequency of EKG tests in 12 mo. period | Standard Deviation 0.39 |
| Patient Self-Directed Care | Change in Lab Monitoring - EKG | 12 month follow-up | 0.13 frequency of EKG tests in 12 mo. period | Standard Deviation 0.43 |
| Patient Self-Directed Care | Change in Lab Monitoring - EKG | 24 month follow-up | 0.10 frequency of EKG tests in 12 mo. period | Standard Deviation 0.34 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - EKG | Baseline | 0.15 frequency of EKG tests in 12 mo. period | Standard Deviation 0.51 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - EKG | 12 month follow-up | 0.16 frequency of EKG tests in 12 mo. period | Standard Deviation 0.49 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - EKG | 24 month follow-up | 0.12 frequency of EKG tests in 12 mo. period | Standard Deviation 0.42 |
Comparison: Test for treatment by time interactionp-value: 0.4715Mixed Models Analysis
Comparison: Test for change over time (only calculated if treatment by time interaction non-significant)p-value: 0.9209Mixed Models Analysis
Secondary
Change in Lab Monitoring - Glucose
Frequency of glucose lab tests in 12 month periods
Time frame: Updated annually using claims data over 2 year active intervention period
Population: Study participants who were Medicaid eligible for 80% of the year prior to the data collection time point
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Lab Monitoring - Glucose | Baseline | 1.55 frequency of lab tests in 12 mo. period | Standard Deviation 2.55 |
| Patient Self-Directed Care | Change in Lab Monitoring - Glucose | 12 month follow-up | 1.46 frequency of lab tests in 12 mo. period | Standard Deviation 2.69 |
| Patient Self-Directed Care | Change in Lab Monitoring - Glucose | 24 month follow-up | 1.41 frequency of lab tests in 12 mo. period | Standard Deviation 2.31 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Glucose | Baseline | 1.21 frequency of lab tests in 12 mo. period | Standard Deviation 2.52 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Glucose | 12 month follow-up | 1.33 frequency of lab tests in 12 mo. period | Standard Deviation 2.65 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Glucose | 24 month follow-up | 1.16 frequency of lab tests in 12 mo. period | Standard Deviation 2.5 |
Comparison: Test for treatment by time interactionp-value: <0.0001Mixed Models Analysis
Secondary
Change in Lab Monitoring - Lipids
Frequency of lipid lab tests in 12 month periods
Time frame: Updated annually using claims data over 2 year active intervention period
Population: Study participants who were Medicaid eligible for 80% of the year prior to the data collection time point
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Lab Monitoring - Lipids | Baseline | 0.37 frequency of lab tests in 12 mo. period | Standard Deviation 0.74 |
| Patient Self-Directed Care | Change in Lab Monitoring - Lipids | 12 month follow-up | 0.35 frequency of lab tests in 12 mo. period | Standard Deviation 0.73 |
| Patient Self-Directed Care | Change in Lab Monitoring - Lipids | 24 month follow-up | 0.40 frequency of lab tests in 12 mo. period | Standard Deviation 0.73 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Lipids | Baseline | 0.41 frequency of lab tests in 12 mo. period | Standard Deviation 0.86 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Lipids | 12 month follow-up | 0.46 frequency of lab tests in 12 mo. period | Standard Deviation 0.9 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Lipids | 24 month follow-up | 0.46 frequency of lab tests in 12 mo. period | Standard Deviation 1.39 |
Comparison: Test for treatment by time interactionp-value: 0.0202Mixed Models Analysis
Secondary
Change in Lab Monitoring - Overall
Frequency of lab tests (glucose, lipids, EKG) in 12 month periods
Time frame: Updated annually using claims data over 2 year active intervention period
Population: Study participants who were Medicaid eligible for 80% of the year prior to the data collection time point
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Lab Monitoring - Overall | Baseline | 1.67 frequency of lab tests in 12 mo. period | Standard Deviation 2.64 |
| Patient Self-Directed Care | Change in Lab Monitoring - Overall | 12 month follow-up | 1.60 frequency of lab tests in 12 mo. period | Standard Deviation 2.79 |
| Patient Self-Directed Care | Change in Lab Monitoring - Overall | 24 month follow-up | 1.52 frequency of lab tests in 12 mo. period | Standard Deviation 2.36 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Overall | Baseline | 1.37 frequency of lab tests in 12 mo. period | Standard Deviation 2.65 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Overall | 12 month follow-up | 1.49 frequency of lab tests in 12 mo. period | Standard Deviation 2.79 |
| Provider-Supported Integrated Care | Change in Lab Monitoring - Overall | 24 month follow-up | 1.30 frequency of lab tests in 12 mo. period | Standard Deviation 2.7 |
Comparison: Test for treatment by time interactionp-value: 0.0029Mixed Models Analysis
Secondary
Change in Medication Adherence - Antidepressants
Claims data used to calculate antidepressant medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: The N for the time point with the greatest # of participants who were prescribed am antidepressant medication.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Medication Adherence - Antidepressants | 6 month follow-up | 0.79 Medication possession ratio | Standard Deviation 0.29 |
| Patient Self-Directed Care | Change in Medication Adherence - Antidepressants | 18 month follow-up | 0.81 Medication possession ratio | Standard Deviation 0.29 |
| Patient Self-Directed Care | Change in Medication Adherence - Antidepressants | 12 month follow-up | 0.81 Medication possession ratio | Standard Deviation 0.27 |
| Patient Self-Directed Care | Change in Medication Adherence - Antidepressants | 24 month follow-up | 0.83 Medication possession ratio | Standard Deviation 0.27 |
| Patient Self-Directed Care | Change in Medication Adherence - Antidepressants | Baseline | 0.79 Medication possession ratio | Standard Deviation 0.31 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antidepressants | 24 month follow-up | 0.82 Medication possession ratio | Standard Deviation 0.26 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antidepressants | Baseline | 0.84 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antidepressants | 6 month follow-up | 0.86 Medication possession ratio | Standard Deviation 0.24 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antidepressants | 12 month follow-up | 0.84 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antidepressants | 18 month follow-up | 0.82 Medication possession ratio | Standard Deviation 0.27 |
Comparison: Test for treatment by time interactionp-value: 0.1653Mixed Models Analysis
Comparison: Test for change over time (only calculated if treatment by time interaction non-significant)p-value: 0.1772Mixed Models Analysis
Secondary
Change in Medication Adherence - Antipsychotics
Claims data used to calculate antipsychotic medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: The N for the time point with the greatest # of participants who were prescribed a antipsychotic medication.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Medication Adherence - Antipsychotics | 6 month follow-up | 0.70 Medication possession ratio | Standard Deviation 0.32 |
| Patient Self-Directed Care | Change in Medication Adherence - Antipsychotics | 18 month follow-up | 0.78 Medication possession ratio | Standard Deviation 0.26 |
| Patient Self-Directed Care | Change in Medication Adherence - Antipsychotics | 12 month follow-up | 0.74 Medication possession ratio | Standard Deviation 0.32 |
| Patient Self-Directed Care | Change in Medication Adherence - Antipsychotics | 24 month follow-up | 0.78 Medication possession ratio | Standard Deviation 0.28 |
| Patient Self-Directed Care | Change in Medication Adherence - Antipsychotics | Baseline | 0.73 Medication possession ratio | Standard Deviation 0.29 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antipsychotics | 24 month follow-up | 0.81 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antipsychotics | Baseline | 0.81 Medication possession ratio | Standard Deviation 0.26 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antipsychotics | 6 month follow-up | 0.80 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antipsychotics | 12 month follow-up | 0.82 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Antipsychotics | 18 month follow-up | 0.78 Medication possession ratio | Standard Deviation 0.28 |
Comparison: Test for treatment by time interactionp-value: 0.1183Mixed Models Analysis
Comparison: Test for change over time (only calculated if treatment by time interaction non-significant)p-value: 0.0569Mixed Models Analysis
Secondary
Change in Medication Adherence - Diabetes
Claims data used to calculate diabetes medication possession ratio (MPO) for participants diagnosed with diabetes in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: The N for the time point with the greatest # of participants who were prescribed a diabetes medication.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Medication Adherence - Diabetes | Baseline | 0.78 Medication possession ratio | Standard Deviation 0.3 |
| Patient Self-Directed Care | Change in Medication Adherence - Diabetes | 18 month follow-up | 0.86 Medication possession ratio | Standard Deviation 0.23 |
| Patient Self-Directed Care | Change in Medication Adherence - Diabetes | 12 month follow-up | 0.83 Medication possession ratio | Standard Deviation 0.27 |
| Patient Self-Directed Care | Change in Medication Adherence - Diabetes | 24 month follow-up | 0.77 Medication possession ratio | Standard Deviation 0.32 |
| Patient Self-Directed Care | Change in Medication Adherence - Diabetes | 6 month follow-up | 0.86 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Diabetes | 24 month follow-up | 0.91 Medication possession ratio | Standard Deviation 0.17 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Diabetes | Baseline | 0.89 Medication possession ratio | Standard Deviation 0.2 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Diabetes | 6 month follow-up | 0.91 Medication possession ratio | Standard Deviation 0.2 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Diabetes | 12 month follow-up | 0.91 Medication possession ratio | Standard Deviation 0.17 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Diabetes | 18 month follow-up | 0.88 Medication possession ratio | Standard Deviation 0.24 |
Comparison: Test for treatment by time interactionp-value: 0.0001Mixed Models Analysis
Secondary
Change in Medication Adherence - Hypertension
Claims data used to calculate antihypertensive medication possession ratio (MPR) for participants in 6 month time periods. If the (first\_fill - last\_end\_Date) \> 180 then MPR = (total days supply - (first\_fill - last\_end\_Date) - 180 ) / 180. If the total duration was not greater than 180 days, MPR = total days supply / 180.
Time frame: Updated annually using claims data over 2 year active intervention period
Population: The N for the time point with the greatest # of participants who were prescribed a antihypertensive medication.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Medication Adherence - Hypertension | 6 month follow-up | 0.73 Medication possession ratio | Standard Deviation 0.31 |
| Patient Self-Directed Care | Change in Medication Adherence - Hypertension | 18 month follow-up | 0.81 Medication possession ratio | Standard Deviation 0.28 |
| Patient Self-Directed Care | Change in Medication Adherence - Hypertension | 12 month follow-up | 0.76 Medication possession ratio | Standard Deviation 0.29 |
| Patient Self-Directed Care | Change in Medication Adherence - Hypertension | 24 month follow-up | 0.83 Medication possession ratio | Standard Deviation 0.3 |
| Patient Self-Directed Care | Change in Medication Adherence - Hypertension | Baseline | 0.75 Medication possession ratio | Standard Deviation 0.31 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Hypertension | 24 month follow-up | 0.82 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Hypertension | Baseline | 0.76 Medication possession ratio | Standard Deviation 0.3 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Hypertension | 6 month follow-up | 0.79 Medication possession ratio | Standard Deviation 0.3 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Hypertension | 12 month follow-up | 0.82 Medication possession ratio | Standard Deviation 0.27 |
| Provider-Supported Integrated Care | Change in Medication Adherence - Hypertension | 18 month follow-up | 0.80 Medication possession ratio | Standard Deviation 0.28 |
Comparison: Test for treatment by time interactionp-value: 0.0745Mixed Models Analysis
Comparison: Test for change over time (only calculated if treatment by time interaction non-significant)p-value: <0.0001Mixed Models Analysis
Secondary
Change in Patient Satisfaction With Care
Change in patient satisfaction with care was assessed using the Patient Assessment of Care for Chronic Conditions (PACIC). Each item of the PACIC is on a 1 to 5 scale. The total score is the average of all 20 item scores. Higher scores represent increased frequency of structured chronic care.
Time frame: Baseline and every 6 months over 2 year active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Patient Satisfaction With Care | Baseline | 2.99 Units on a scale | Standard Deviation 1.06 |
| Patient Self-Directed Care | Change in Patient Satisfaction With Care | 18 month follow-up | 3.16 Units on a scale | Standard Deviation 1.03 |
| Patient Self-Directed Care | Change in Patient Satisfaction With Care | 12 month follow-up | 3.25 Units on a scale | Standard Deviation 0.99 |
| Patient Self-Directed Care | Change in Patient Satisfaction With Care | 24 month follow-up | 3.17 Units on a scale | Standard Deviation 1.1 |
| Patient Self-Directed Care | Change in Patient Satisfaction With Care | 6 month follow-up | 3.17 Units on a scale | Standard Deviation 1.04 |
| Provider-Supported Integrated Care | Change in Patient Satisfaction With Care | 24 month follow-up | 3.37 Units on a scale | Standard Deviation 0.95 |
| Provider-Supported Integrated Care | Change in Patient Satisfaction With Care | 6 month follow-up | 3.23 Units on a scale | Standard Deviation 0.95 |
| Provider-Supported Integrated Care | Change in Patient Satisfaction With Care | Baseline | 3.17 Units on a scale | Standard Deviation 0.96 |
| Provider-Supported Integrated Care | Change in Patient Satisfaction With Care | 12 month follow-up | 3.31 Units on a scale | Standard Deviation 0.95 |
| Provider-Supported Integrated Care | Change in Patient Satisfaction With Care | 18 month follow-up | 3.25 Units on a scale | Standard Deviation 0.95 |
Comparison: Test for treatment by time interactionp-value: 0.0021Mixed Models Analysis
Secondary
Change in Quality of Life (QLESQ)
Patient quality of life is measured using the QLESQ (Quality of Life Enjoyment and Satisfaction Questionnaire) in which participants respond on a scale of 1 (very poor) to 5 (very good) their level of satisfaction with a variety of social and physical domains. The total raw score ranges from 14 to 70 or 0-100%. Only the first 14 items yield the raw total score as the last two items are standalone. The raw total score is transformed into a percentage maximum possible score using the following formula: (raw total score-minimum score)/(maximum possible raw score-minimum score). The lower values/percentages represent a poor outcome while higher values/percentages represent a better outcome. The information below reflects raw scores (rather than percentages).
Time frame: Baseline and every 6 months over 2 year active intervention period
Population: Includes those who completed the measure at baseline and whose measure was able to be scored (ie. was not missing data which would have rendered it unusable in analysis)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Patient Self-Directed Care | Change in Quality of Life (QLESQ) | 6 month follow-up | 42.29 Units on a scale | Standard Deviation 11.32 |
| Patient Self-Directed Care | Change in Quality of Life (QLESQ) | Baseline | 42.00 Units on a scale | Standard Deviation 11.6 |
| Patient Self-Directed Care | Change in Quality of Life (QLESQ) | 12 month follow-up | 44.52 Units on a scale | Standard Deviation 10.36 |
| Patient Self-Directed Care | Change in Quality of Life (QLESQ) | 18 month follow-up | 43.10 Units on a scale | Standard Deviation 10.75 |
| Patient Self-Directed Care | Change in Quality of Life (QLESQ) | 24 month follow-up | 43.98 Units on a scale | Standard Deviation 11.65 |
| Provider-Supported Integrated Care | Change in Quality of Life (QLESQ) | 24 month follow-up | 45.80 Units on a scale | Standard Deviation 12.02 |
| Provider-Supported Integrated Care | Change in Quality of Life (QLESQ) | 18 month follow-up | 44.88 Units on a scale | Standard Deviation 11.34 |
| Provider-Supported Integrated Care | Change in Quality of Life (QLESQ) | 12 month follow-up | 44.35 Units on a scale | Standard Deviation 11.42 |
| Provider-Supported Integrated Care | Change in Quality of Life (QLESQ) | Baseline | 44.38 Units on a scale | Standard Deviation 11.12 |
| Provider-Supported Integrated Care | Change in Quality of Life (QLESQ) | 6 month follow-up | 45.76 Units on a scale | Standard Deviation 11.09 |
Comparison: Treatment by time interaction testp-value: 0.0014Mixed Models Analysis