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Purpose

The purpose of this study is to measure the evidence-based intervention's (EBIs) impact on patient safety and efficiency, to assess the EBIs implementation by measuring acceptability, appropriateness, cost, fidelity, penetration, and sustainability and to identify the facilitators and barriers that influence the degree of implementation of these EBIs.

Conditions

Eligibility

Eligible Ages
Over 18 Years
Eligible Sex
All
Accepts Healthy Volunteers
No

Criteria

Primary care providers' inclusion criteria:

- physicians, physicians assistants and advanced practice registered nurses in the 13
clinic locations of UTP are eligible if they care for patients at the time patient
enrollment at their clinic begins

- agree to participate.

Patients' inclusion criteria are:

- hemoglobin result < 10.8 for females and < 12.5 for males with normal white cell
count and platelet count (the prior hemoglobin results must have been in normal
range, with a look-back period of two years)

- an eGFR value < 60 (the prior eGFR results must have been in normal range, with a
look-back range of two years)

- the matching creatinine results must also be in normal range

- not pregnant

- speak English or Spanish.

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Crossover Assignment
Intervention Model Description
This is a stepped wedge cluster-randomized trial. There will be 4 clusters, with 3-4 clinics per cluster. In a stepped wedge fashion, the 4 clusters will receive the control followed by the study intervention--that is, in the first step the first cluster will receive the intervention after 6 months of control, in the second step the second cluster will receive intervention after 12 months of control, in the third step the third cluster will receive the intervention after 18 months of control, and in the fourth step the fourth cluster will receive the intervention after 24 months of control.
Primary Purpose
Health Services Research
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Experimental: Step 1 (3 clinics) - 24 months of intervention
  • Other: Enhanced diagnostic team implementing three evidence-based interventions
    we designed an enhanced team process entailing: 1) using automated abnormal test result detection and tracking; 2) expanding the primary care team to include CPs to guide the evaluation of anemia to identify underlying causes; and 3) using NNs to engage patients in the healthcare team and diagnostic process and increase patient activation.
  • Other: Usual care
    Usual care involves primary care physicians ordering additional tests and referrals to evaluate patients with new anemia and decreased glomerular filtration rate (GFR) .
    Other names:
    • Control
Experimental
Experimental: Step 2 (3 clinics) - 1 month of control followed by 18 months of intervention
  • Other: Enhanced diagnostic team implementing three evidence-based interventions
    we designed an enhanced team process entailing: 1) using automated abnormal test result detection and tracking; 2) expanding the primary care team to include CPs to guide the evaluation of anemia to identify underlying causes; and 3) using NNs to engage patients in the healthcare team and diagnostic process and increase patient activation.
  • Other: Usual care
    Usual care involves primary care physicians ordering additional tests and referrals to evaluate patients with new anemia and decreased glomerular filtration rate (GFR) .
    Other names:
    • Control
Experimental
Experimental: Step 3 (3 clinics) - 2 months control followed by 12 months of intervention
  • Other: Enhanced diagnostic team implementing three evidence-based interventions
    we designed an enhanced team process entailing: 1) using automated abnormal test result detection and tracking; 2) expanding the primary care team to include CPs to guide the evaluation of anemia to identify underlying causes; and 3) using NNs to engage patients in the healthcare team and diagnostic process and increase patient activation.
  • Other: Usual care
    Usual care involves primary care physicians ordering additional tests and referrals to evaluate patients with new anemia and decreased glomerular filtration rate (GFR) .
    Other names:
    • Control
Experimental
Experimental: Step 4 (4 clinics) - 2 months control followed by 12 months of intervention
  • Other: Enhanced diagnostic team implementing three evidence-based interventions
    we designed an enhanced team process entailing: 1) using automated abnormal test result detection and tracking; 2) expanding the primary care team to include CPs to guide the evaluation of anemia to identify underlying causes; and 3) using NNs to engage patients in the healthcare team and diagnostic process and increase patient activation.
  • Other: Usual care
    Usual care involves primary care physicians ordering additional tests and referrals to evaluate patients with new anemia and decreased glomerular filtration rate (GFR) .
    Other names:
    • Control

Recruiting Locations

The University of Texas Health Science Center at Houston
Houston 4699066, Texas 4736286 77030
Contact:
Eric Thomas, MD, MPH
713-500-7958
Eric.Thomas@uth.tmc.edu

More Details

Status
Recruiting
Sponsor
The University of Texas Health Science Center, Houston

Study Contact

Eric Thomas, MD,MPH
713-500-7958
Eric.Thomas@uth.tmc.edu

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.