Karen I Connor1, Eric M Cheng2, Frances Barry2, Hilary C Siebens2, Martin L Lee2, David A Ganz2, Brian S Mittman2, Megan K Connor2, Lisa K Edwards2, Michael G McGowan2, Barbara G Vickrey2. 1. From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY. kiconnor@ucla.edu. 2. From the Veterans Affairs Greater Los Angeles Parkinson's Disease Research, Education and Clinical Center (K.I.C., L.K.E., M.G.M.); University of California Los Angeles David Geffen School of Medicine (K.I.C., E.M.C., F.B.); Siebens Patient Care Communications LLC (H.C.S.), Seal Beach; Veterans Affairs Sepulveda Ambulatory Care Center (M.L.L.), North Hills; University of California Los Angeles Fielding School of Public Health (M.L.L.); Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy (D.A.G.), Los Angeles; Kaiser Permanente Research (B.S.M.), Pasadena; University of California San Francisco (M.K.C.); and Icahn School of Medicine at Mount Sinai (B.G.V.), New York, NY.
Abstract
OBJECTIVE: To test effects on care quality of Chronic Care Model-based Parkinson disease (PD) management. METHODS: This 2-group stratified randomized trial involved 328 veterans with PD in southwestern United States. Guided care management, led by PD nurses, was compared to usual care. Primary outcomes were adherence to 18 PD care quality indicators. Secondary outcomes were patient-centered outcome measures. Data sources were telephone survey and electronic medical record (EMR). Outcomes were analyzed as intent-to-treat comparing initial and final survey and repeated-measures mixed-effects models. RESULTS:Average age was 71 years; 97% of participants were male. Mean proportion of participants receiving recommended PD care indicators was significantly higher for the intervention than for usual care (0.77 vs 0.58) (mean difference 0.19, 95% confidence interval [CI] 0.16, 0.22). Of 8 secondary outcomes, the only significant difference of the changes over time was in the positive Patient Health Questionnaire-2 depression screen for intervention minus usual care (-11.52 [95% CI -20.42, -2.62]). CONCLUSION: A nurse-led chronic care management intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), substantially increased adherence to PD quality of care indicators among veterans with PD, as documented in the EMR. Of 8 secondary outcomes assessed, a screening measure for depressive symptomatology was the only measure that was better in the intervention compared to usual care. More telephone calls in CHAPS were the only utilization difference over usual care. While CHAPS appears promising for improving PD care, additional iterative research is needed to refine the CHAPS model in routine clinical care so that it measurably improves patient-centered outcomes (NCT01532986). CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with PD, CHAPS increased adherence to PD quality of care indicators.
RCT Entities:
OBJECTIVE: To test effects on care quality of Chronic Care Model-based Parkinson disease (PD) management. METHODS: This 2-group stratified randomized trial involved 328 veterans with PD in southwestern United States. Guided care management, led by PD nurses, was compared to usual care. Primary outcomes were adherence to 18 PD care quality indicators. Secondary outcomes were patient-centered outcome measures. Data sources were telephone survey and electronic medical record (EMR). Outcomes were analyzed as intent-to-treat comparing initial and final survey and repeated-measures mixed-effects models. RESULTS: Average age was 71 years; 97% of participants were male. Mean proportion of participants receiving recommended PD care indicators was significantly higher for the intervention than for usual care (0.77 vs 0.58) (mean difference 0.19, 95% confidence interval [CI] 0.16, 0.22). Of 8 secondary outcomes, the only significant difference of the changes over time was in the positive Patient Health Questionnaire-2 depression screen for intervention minus usual care (-11.52 [95% CI -20.42, -2.62]). CONCLUSION: A nurse-led chronic care management intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), substantially increased adherence to PD quality of care indicators among veterans with PD, as documented in the EMR. Of 8 secondary outcomes assessed, a screening measure for depressive symptomatology was the only measure that was better in the intervention compared to usual care. More telephone calls in CHAPS were the only utilization difference over usual care. While CHAPS appears promising for improving PD care, additional iterative research is needed to refine the CHAPS model in routine clinical care so that it measurably improves patient-centered outcomes (NCT01532986). CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with PD, CHAPS increased adherence to PD quality of care indicators.
Authors: Barbara G Vickrey; Brian S Mittman; Karen I Connor; Marjorie L Pearson; Richard D Della Penna; Theodore G Ganiats; Robert W Demonte; Joshua Chodosh; Xinping Cui; Stefanie Vassar; Naihua Duan; Martin Lee Journal: Ann Intern Med Date: 2006-11-21 Impact factor: 25.391
Authors: Amytis Towfighi; Eric M Cheng; Monica Ayala-Rivera; Frances Barry; Heather McCreath; David A Ganz; Martin L Lee; Nerses Sanossian; Bijal Mehta; Tara Dutta; Ali Razmara; Robert Bryg; Shlee S Song; Phyllis Willis; Shinyi Wu; Magaly Ramirez; Adam Richards; Nicholas Jackson; Jeremy Wacksman; Brian Mittman; Jamie Tran; Renee R Johnson; Chris Ediss; Theresa Sivers-Teixeira; Betty Shaby; Ana L Montoya; Marilyn Corrales; Elizabeth Mojarro-Huang; Marissa Castro; Patricia Gomez; Cynthia Muñoz; Diamond Garcia; Lilian Moreno; Maura Fernandez; Enrique Lopez; Sarah Valdez; Hilary R Haber; Valerie A Hill; Neal M Rao; Beatrice Martinez; Lillie Hudson; Natalie P Valle; Barbara G Vickrey Journal: JAMA Netw Open Date: 2021-02-01
Authors: Karen I Connor; Hilary C Siebens; Brian S Mittman; Donna K McNeese-Smith; David A Ganz; Frances Barry; Lisa K Edwards; Michael G McGowan; Eric M Cheng; Barbara G Vickrey Journal: BMC Neurol Date: 2020-12-02 Impact factor: 2.474
Authors: Karen I Connor; Hilary C Siebens; Brian S Mittman; David A Ganz; Frances Barry; Donna K McNeese-Smith; Eric M Cheng; Barbara G Vickrey Journal: BMC Neurol Date: 2022-01-24 Impact factor: 2.474
Authors: Karen I Connor; Hilary C Siebens; Brian S Mittman; David A Ganz; Frances Barry; E J Ernst; Lisa K Edwards; Michael G McGowan; Donna K McNeese-Smith; Eric M Cheng; Barbara G Vickrey Journal: BMC Health Serv Res Date: 2020-08-10 Impact factor: 2.655
Authors: Angelika D van Halteren; Marten Munneke; Eva Smit; Sue Thomas; Bastiaan R Bloem; Sirwan K L Darweesh Journal: J Parkinsons Dis Date: 2020 Impact factor: 5.568