Multiple Chronic Conditions
Conditions
Keywords
Patient-Centered Care, Prevention, Integrated care, Electronic Health Records, Randomized controlled trial, Patient summary, Treatment plan, Decision Making, Shared
Brief summary
The case history of patients with complex and long-term needs is often stored in fragments across many different care providers, each with a separate electronic health record. Even when the notes are stored in the same organization, the large volume of information makes it difficult for practitioners to grasp the full overview of the patient's situation. The DigiTeam tool, combines information management features to present notes from across the care pathway from the three main providers: General Practice, Health and Social care Services, and Secondary care. It also includes summaries of the patient's concerns, conditions, and treatment plan. It provides links to the source documents that are the basis for the summaries. The overarching aim is to examine the effect of physicians' use of the DigiTeam for three patient cases derived from real-world pseudonymized notes, on the quality of the physcians' ensuing case summary and treatment plan. In the comparator arms, physicians use usual care tools, i.e. only one or three sources of notes and no information management features.
Interventions
OTHER03 - Summaries of and clinical notes from several providers
Access to all clinical notes across three providers: General practitioner, Social services and Specialist care, like in arm 02. In addition, access to information management features, such as summaries of patient's priorities, and clinical summaries of key health problems, including links to source documents.
OTHER01 - Clinical notes from one provider
Access to all clinical notes available to the provider in the patient's case. The provider is General practice in two patient cases, and hospital in one patient case.
OTHER02 - Access to notes from primary and secondary care
Access to all clinical notes across three providers: General practitioner, Social services and Specialist care.
Sponsors
Norwegian University of Science and Technology
University Hospital of North Norway
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
The Outcome Assessor of the primary outcome is a large language model, which assesses the answers provided by the participants without any information about group allocation.
Intervention model description
Participants are block randomized to balance the three arms (Usual care, 3 sources, Summaries). The sizes of the blocks are set by a trial service office, and not known to those involved in the trial.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* General practitioner OR * Physician who has graduated within the last five years. If the recruitment is difficult, medical students and other physicians may be included. To recruit participants, the trial will be announced through known networks, social media, the researchers' network, and general announcements.
Exclusion criteria
* There is no exclusion criterium.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quality of patient summary and follow-up plan | Immediately after completing the the task for each patient | The primary outcome is the quality of the patient summary and follow-up plan Participants are asked to create a summary as preparation for a care planning meeting with colleagues, using the information available in the digital tool to write 1) a Comprehensive summary of the patient's situation and 2. A care plan. Quality of summaries and care plans will be measured by Microsoft Copilot. An expert group of three clinicians will create gold-standard summaries. These will be converted into a list of clear, mutually exclusive items using standardized rules. Copilot will be prompted to identify whether each item is present in participant responses. The item list will be validated by comparing scoring consistency (Kappa statistics) between researchers and Copilot, aiming for ≥0.7 agreement with researchers and ≥0.9 between Copilot runs. Final scores will reflect the number of items included per response. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| System Usability Scale | Immediately after completing the the task for each patient | The usability of the intervention to do the work needed for each patient will be measured with the System Usability Scale which contains ten items scored from one (strongly disagree) to five (strongly agree) that are transformed to a 0 to 100 scale and translated into a curved grading scale from A-F |
| Time spent completeing the patient case overviews and follow-up plans | Immediately after completing the the task for each patient | Time from start of case to delivery of answer as measured by participant reported start and stop time. |
| Information support for solving tasks | Immediately after completing the the task for each patient | To compare how the different interventions helped to solve the task described under primary outcome, the following questions will be asked: On a scale of 1 to 5 (1 Poor 2 Fair 3 Good 4 Very good 5 Excellent), how did the information you had access to support you to find information about * Current medical status? * Social or personal circumstances that contribute to the current status? * What is important to the patient? * What should be followed up further? * Who should be involved in the follow-up? |
| Experience with conducting the task | Immediately after completing the the task for each patient | To compare the experience with the digital tool used to conduct the tasks, the following questions will be used: On a scale of 1 to 5 (1 Poor 2 Fair 3 Good 4 Very good 5 Excellent) * What do you think about the tool overall? * How good was the support in the tool to find the information you needed? * How useful was the training in using the tool? * How did the tool work compared to tools you use daily for similar tasks? * How would such a tool fit into your daily work? Would you recommend the tool to colleagues? (Yes Unsure No) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Time spent on various activities | Immediately after completing the the task for each patient | To describe the time used on various activities in the digital tool, the following variables will be automatically recorded in the tool: * Time spent in each main area: The main areas are the main pages in the side menu, like information about the patient, the list of clinical notes and the medication list. * Inactivity \>10 seconds: The time the participant reads/writes. * Number of unique clinical notes that are opened. * Number of free text searches conducted. |
| Experience with the type of patients | Immediately after completing the the task for each patient | To describe whether the participants had experiences with the types of patients, the following question will be asked: How often do you work with patients who have as complex and long-term needs as this patient? (Weekly, Monthly, Semi-annually or less frequently) |
| Technical problems | Immediately after completing the the task for each patient | To describe the experience with the digital solution used, the following question will be used Did you have any technical problems in completing this task? No, none at all Some, but it was minimal Yes, quite extensive. |
Countries
Norway
Outcome results
None listed