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Walker RJB, Choi WJ, Ribeiro T, Habib RA, Zhu A, Tan C, Bui EC, da Costa BR, Karanicolas PJ. Factors Associated With Loss to Follow-Up in Surgical Trials: A Systematic Review and Meta-Analysis. J Surg Res 2024; 300:33-42. [PMID: 38795671 DOI: 10.1016/j.jss.2024.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/19/2024] [Accepted: 04/21/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Loss to follow-up (LTFU) distorts results of randomized controlled trials (RCTs). Understanding trial characteristics that contribute to LTFU may enable investigators to anticipate the extent of LTFU and plan retention strategies. The objective of this systematic review and meta-analysis was to investigate the extent of LTFU in surgical RCTs and evaluate associations between trial characteristics and LTFU. METHODS MEDLINE, Embase, and PubMed Central were searched for surgical RCTs published between January 2002 and December 2021 in the 30 highest impact factor surgical journals. Two-hundred eligible RCTs were randomly selected. The pooled LTFU rate was estimated using random intercept Poisson regression. Associations between trial characteristics and LTFU were assessed using metaregression. RESULTS The 200 RCTs included 37,914 participants and 1307 LTFU events. The pooled LTFU rate was 3.10 participants per 100 patient-years (95% confidence interval [CI] 1.85-5.17). Trial characteristics associated with reduced LTFU were standard-of-care outcome assessments (rate ratio [RR] 0.17; 95% CI 0.06-0.48), surgery for transplantation (RR 0.08; 95% CI 0.01-0.43), and surgery for cancer (RR 0.10; 95% CI 0.02-0.53). Increased LTFU was associated with patient-reported outcomes (RR 14.21; 95% CI 4.82-41.91) and follow-up duration ≥ three months (odds ratio 10.09; 95% CI 4.79-21.28). CONCLUSIONS LTFU in surgical RCTs is uncommon. Participants may be at increased risk of LTFU in trials with outcomes assessed beyond the standard of care, surgical indications other than cancer or transplant, patient-reported outcomes, and longer follow-up. Investigators should consider the impact of design on LTFU and plan retention strategies accordingly.
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Affiliation(s)
- Richard J B Walker
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Woo Jin Choi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tiago Ribeiro
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Razan A Habib
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alice Zhu
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Chunyi Tan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Evan Chung Bui
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bruno R da Costa
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Applied Health Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
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McClure J, Asghar A, Krajec A, Johnson MR, Subramanian S, Caroff K, McBurney C, Perusich S, Garcia A, Beck DJ, Huang GD. Clinical trial facilitators: A novel approach to support the execution of clinical research at the study site level. Contemp Clin Trials Commun 2023; 33:101106. [PMID: 37063166 PMCID: PMC10028341 DOI: 10.1016/j.conctc.2023.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023] Open
Abstract
In the summer of 2020, multiple efforts were undertaken to establish safe and effective vaccines to combat the spread of the coronavirus disease (COVID-19). In the United States (U.S.), Operation Warp Speed (OWS) was the program designated to coordinate such efforts. OWS was a partnership between the Department of Health and Human Services (HHS), the Department of Defense (DOD), and the private sector, that aimed to help accelerate control of the COVID-19 pandemic by advancing development, manufacturing, and distribution of vaccines, therapeutics, and diagnostics. The U.S. Department of Veterans Affairs’ (VA) was identified as a potential collaborator in several large-scale OWS Phase III clinical trial efforts designed to evaluate the safety and efficacy of various vaccines that were in development. Given the global importance of these trials, it was recognized that there would be a need for a coordinated, centralized effort within VA to ensure that its medical centers (sites) would be ready and able to efficiently initiate, recruit, and enroll into these trials. The manuscript outlines the partnership and start-up activities led by two key divisions of the VA's Office of Research and Development's clinical research enterprise. These efforts focused on site and enterprise-level requirements for multiple trials, with one trial serving as the most prominently featured of these studies within the VA. As a result, several best practices arose that included designating clinical trial facilitators to study sites to support study initiation activities and successful study enrollment at these locations in an efficient and timely fashion.
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Affiliation(s)
| | | | | | - Marcus R. Johnson
- Durham VA Health Care System, USA
- Corresponding author. 508 Fulton Street (152), Durham, NC 27705, USA.
| | | | - Krissa Caroff
- Office of Research and Development, USA
- U.S. Department of Veterans Affairs, USA
| | | | | | - Amanda Garcia
- U.S. Department of Veterans Affairs, USA
- VA Cooperative Studies Program Central Office, USA
| | | | - Grant D. Huang
- Office of Research and Development, USA
- U.S. Department of Veterans Affairs, USA
- VA Cooperative Studies Program Central Office, USA
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Okorie CL, Gatsby E, Schroeck FR, Ould Ismail AA, Lynch KE. Using electronic health records to streamline provider recruitment for implementation science studies. PLoS One 2022; 17:e0267915. [PMID: 35560153 PMCID: PMC9106149 DOI: 10.1371/journal.pone.0267915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common provider screening strategies but require substantial time, effort, and resources. The automated use of electronic health record (EHR) data may streamline provider identification for implementation science research. Here, we describe an approach to provider screening for a Veterans Health Administration (VHA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Methods Our goal was to identify providers at 6 pre-specified facilities who performed ≥10 surveillance cystoscopy procedures among bladder cancer patients in the 12 months prior to recruitment start on January 16, 2020, and who were currently practicing at 1 of 6 pre-specified facilities. Using VHA EHR data (using CPT, ICD10 procedure, and ICD10 diagnosis codes), we identified cystoscopy procedures performed after an initial bladder cancer diagnosis (i.e., surveillance procedures). Procedures were linked to VHA staff data to determine the provider of record, the number of cystoscopies they performed, and their current location of practice. To validate this approach, we performed a chart review of 105 procedures performed by a random sample of identified providers. The proportion of correctly identified procedures was calculated (Positive Predictive Value (PPV)), along with binomial 95% confidence intervals (CI). Findings We identified 1,917,856 cystoscopies performed on 703,324 patients from October 1, 1999—January 16, 2020, across the nationwide VHA. Of those procedures, 40% were done on patients who had a prior record of bladder cancer and were completed by 15,065 distinct providers. Of those, 61 performed ≥ 10 procedures and were currently practicing at 1 of the 6 facilities of interest in the 1 year prior to study recruitment. The random chart review of 7 providers found 101 of 105 procedures (PPV: 96%; 95% CI: 91% to 99%) were surveillance procedures and were performed by the selected provider on the recorded date. Implications These results show that EHR data can be used for accurate identification of healthcare providers as research participants when inclusion criteria consist of both patient- (temporal relationship between diagnosis and procedure) and provider-level (frequency of procedure and location of current practice) factors. As administrative codes and provider identifiers are collected in most, if not all, EHRs for billing purposes this approach can be translated from provider recruitment in VHA to other healthcare systems. Implementation studies should consider this method of screening providers.
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Affiliation(s)
- Chiamaka L. Okorie
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
| | - Elise Gatsby
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
| | - Florian R. Schroeck
- From Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States of America
- White River Junction VA Medical Center, White River Junction, VT, United States of America
- Section of Urology Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
- Norris Cotton Cancer Center Dartmouth Hitchcock Medical Center, Lebanon, NH, United States of America
| | - A. Aziz Ould Ismail
- White River Junction VA Medical Center, White River Junction, VT, United States of America
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System and University of Utah, Salt Lake City, UT, United States of America
- * E-mail:
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4
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Johnson MR, Raitt M, Asghar A, Condon DL, Beck D, Huang GD. Development and implementation of standardized study performance metrics for a VA healthcare system clinical research consortium. Contemp Clin Trials 2021; 108:106505. [PMID: 34265457 DOI: 10.1016/j.cct.2021.106505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/06/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
The cost of conducting clinical trials is continuously increasing and is driven in large part by the time and resources required to activate trials and reach accrual targets. The impact of low enrollment in a clinical trial can negatively affect the validity of study results and delay its generalizability to the broader population. Quality is a multidimensional concept which could relate to the design, conduct, and analysis of a trial, its clinical relevance, protection/safety of study participants, or quality of reporting. Furthermore, the quality of controlled trials is of obvious relevance to systematic reviews and if the "raw material" or "data" is flawed then the conclusions of systematic reviews cannot be trusted. To date, the literature surrounding the establishment of standardized study enrollment and quality metrics to assess site performance in clinical trial consortiums is scarce. The lack of these metrics presents challenges to study site teams, sponsors, and other clinical research enterprise key stakeholders for adequately monitoring and evaluating study site performance as it relates to fulfilling trial enrollment and quality goals. The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES) undertook an effort to determine the feasibility of establishing and implementing standardized study enrollment and quality metrics for a clinical research consortium (NODES) as a tool to evaluate its performance. In this manuscript, we describe the development and implementation of standardized study enrollment and quality metrics to assess site performance across studies in our clinical research consortium.
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Affiliation(s)
| | | | - Aliya Asghar
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | | | - Grant D Huang
- Cooperative Studies Program, Office of Research & Development, U.S. Department of Veterans Affairs, Washington, DC, USA
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5
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Lipshy KA, Itani K, Chu D, Bahadursingh A, Spector S, Raman K, Dardik A, Tzeng E, Ballantyne GH, John PR, Cmolik B, Maloney J, Kozol R, Longo WE. Sentinel Contributions of US Department of Veterans Affairs Surgeons in Shaping the Face of Health Care. JAMA Surg 2021; 156:380-386. [PMID: 33471058 DOI: 10.1001/jamasurg.2020.6372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The vast accomplishments of the US Department of Veterans Affairs (VA) during the past century have contributed to the advancement of medicine and benefited patients worldwide. This article highlights some of those accomplishments and the advantages in the VA system that promulgated those successes. Through its affiliation with medical schools, its formation of a structured research and development program, its Cooperative Studies Program, and its National Surgical Quality Improvement Program, the VA has led the world in the progress of health care. The exigencies of war led not only to the organization of VA health care but also to groundbreaking, landmark developments in colon surgery; surgical treatments for vascular disease, including vascular grafts, carotid surgery, and arteriovenous dialysis fistulas; cardiac surgery, including implantable cardiac pacemaker and coronary artery bypass surgery; and the surgical management of many conditions, such as hernias. The birth of successful liver transplantation was also seen within the VA, and countless other achievements have benefited patients around the globe. These successes have created an environment where residents and medical students are able to obtain superb education and postgraduate training and where faculty are able to develop their clinical and academic careers.
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Affiliation(s)
- Kenneth A Lipshy
- Department of Surgery, W. G. (Bill) Hefner Veterans Affairs (VA) Health Care System, Salisbury, North Carolina.,Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kamal Itani
- Department of Surgery, VA Boston Health Care System, Boston, Massachusetts.,Department of Surgery, Boston University, Boston, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Danny Chu
- Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anil Bahadursingh
- Department of Surgery, Kansas Veterans Affairs Medical Center (VAMC), Kansas City, Missouri.,Department of Surgery, University of Missouri, Kansas City
| | - Seth Spector
- Department of Surgery, Miami VAMC, Miami, Florida.,Department of Surgery, University of Miami School of Medicine, Miami, Florida
| | - Kathleen Raman
- Department of Surgery, University of Rochester School of Medicine, Rochester, New York
| | - Alan Dardik
- Department of Surgery, West Haven VAMC, West Haven, Connecticut.,Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Edith Tzeng
- Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Preeti R John
- VA Maryland Health Care System, Baltimore.,Department of Surgery, University of Maryland School of Medicine, Baltimore
| | - Brian Cmolik
- Department of Surgery, Cleveland VAMC, Cleveland, Ohio
| | - James Maloney
- Department of Surgery, Madison VAMC, Madison, Wisconsin.,Department of Surgery, University of Wisconsin, Madison
| | | | - Walter E Longo
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Abstract
Background Lung cancer is a leading cause of cancer-related mortality among veterans-as well as the US population-despite veterans' access to advanced medical technologies within the Veterans Health Administration (VHA). To improve outcomes, the VHA launched 3 lung cancer treatment initiatives in 2016 and 2017. Observations This article summarizes the VHA lung cancer initiatives and discusses future programs aimed to improve care for veterans. The US Department of Veterans Affairs (VA) Partnership to Increase Access to Lung Screening aims to reduce lung cancer mortality among veterans at risk by increasing access to low-dose computed tomography lung screening scans. The VALOR study is a randomized phase 3 clinical trial that evaluates optimal treatment for participants with operable early stage non-small cell lung cancer (NSCLC). This trial plans to enroll veterans with stage I NSCLC who will be randomly assigned to treatment with either surgical lobectomy or stereotactic body radiation therapy. Researchers will follow each participant for at least 5 years to evaluate which treatment, if either, results in a higher overall survival rate. The VA Radiation Oncology Quality Surveillance program compares treatment of veterans with lung cancer in the VHA with quality standards recommended by nationally recognized experts in lung cancer care. Conclusions The VHA continues to prioritize resources to improve and assure optimal outcomes for veterans with lung cancer. Future efforts include creating a national network of lung cancer centers of excellence to ensure that treatment decisions for veterans with lung cancer are based on all available molecular information, including data on pharmacogenomic profiles.
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Affiliation(s)
- Drew Moghanaki
- is Section Chief of Radiation Oncology at the Atlanta VA Health Care System in Georgia. is Director of the Veterans Health Administration National Radiation Oncology Program in Richmond, Virginia
| | - Michael Hagan
- is Section Chief of Radiation Oncology at the Atlanta VA Health Care System in Georgia. is Director of the Veterans Health Administration National Radiation Oncology Program in Richmond, Virginia
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7
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Beck D, Asghar A, Kenworthy-Heinige T, Johnson MR, Willis C, Kantorowicz AS, Condon DL, Huang GD. Increasing access to clinical research using an innovative mobile recruitment approach: The (MoRe) concept. Contemp Clin Trials Commun 2020; 19:100623. [PMID: 32775763 PMCID: PMC7403877 DOI: 10.1016/j.conctc.2020.100623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background Access to healthcare delivery programs and systems is a primary correlate to the overall health and well-being of Veterans and the general population. Participation in clinical research is a gateway to novel therapies that are intended to address current global health issues. Meeting or exceeding recruitment goals in clinical research is one of the key determinants of the timely and successful completion of a study. The travel and time burdens experienced by study participants are often considered barriers to their enrollment into clinical research. The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) established a consortium of nine VA medical centers (VAMCs) called the Network of Dedicated Enrollment Sites (NODES). The NODES program provides study site-level expertise and innovative approaches that address challenges to clinical research execution. In alignment with our mission, our program developed an approach to increase study participant access to clinical research through implementing “Mobile Recruitment (MoRe)” units. This manuscript describes the utility and challenges associated with employing this strategy to address three common barriers to clinical research participation: 1) research participant travel burden, 2) participant access to study opportunities, and 3) low participant enrollment. Methods A plan to introduce the Mobile Recruitment (MoRe) unit as a recruitment strategy was piloted for a high-volume, observational cohort study and mega biobank in the VA health care system, the “Million Veteran Program (MVP)”. MoRe is a recruitment strategy for CSP research integrating mobile technology and atypical research recruitment locations. Recruitment locations include primary or main VA hospitals and their assigned VA Community-Based Outpatient Clinics (CBOCs). Each Node site (n = 9) received components of the MoRe unit including a laptop, printer, portable cart with storage space, cooler/ice packs for specimen storage and transport. Each site's usage of these components varied based on its respective needs. Activities focused on both VA main facilities and CBOC facilities for recruitment. Results Seven of the nine Node sites compared the effectiveness of the MoRe unit on MVP study enrollment outcomes over three-time points: pre-intervention period, intervention period, and post-intervention period. The utilization of MoRe in the intervention period demonstrated a 36.9% increase in enrollment compared to the previous six months (pre-intervention period). There was a 2% enrollment increase at the six-month post-intervention period as compared to the intervention period. When comparing the pre-intervention period to the post-intervention period (duration of eighteen months), enrollment increased by 38.9%. Conclusion Five of the seven sites experienced an increase in enrollment during the intervention and post-intervention periods. The two sites without an increase in enrollment experienced various extenuating factors. Characteristics of sites using MoRe included the ability to utilize a smaller, unconventional space, i.e. not a traditional clinical research exam space for recruitment. MoRe was utilized in hospital laboratory space, CBOCs, primary care clinics, and other subspecialty clinics that allowed recruitment activities but did not have dedicated space to offer the research teams for that purpose. This initiative successfully demonstrated the benefit of deploying the unit, proving its utility in cases in where there was a lack of space or alternative workstations for research activities. The implementation of MoRe by NODES as a recruitment strategy for MVP may be transferable to other VA clinical research studies, as well as to other healthcare settings executing similar clinical research activities.
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Affiliation(s)
| | - Aliya Asghar
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | | | | | | | | | - Grant D Huang
- VA Cooperative Studies Program Central Office, US Department of Veterans Affairs, USA
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8
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Velarde KE, Romesser JM, Johnson MR, Clegg DO, Efimova O, Oostema SJ, Scehnet JS, DuVall SL, Huang GD. An initiative using informatics to facilitate clinical research planning and recruitment in the VA health care system. Contemp Clin Trials Commun 2018; 11:107-112. [PMID: 30035242 PMCID: PMC6052195 DOI: 10.1016/j.conctc.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background Randomized clinical trials are the gold standard for evaluating healthcare interventions and, more generally, add to the medical knowledge related to the treatment, diagnosis and prevention of diseases and conditions. Recent literature continues to identify health informatics methods that can help improve study efficiency throughout the life cycle of a clinical trial. Electronic medical record (EMR) data provides a mechanism to facilitate clinical trial research during the study planning and execution phases, and ultimately, can be utilized to enhance recruitment. The Department of Veterans Affairs (VA) has a strong history of clinical and epidemiological research with over four decades of data collected from Veterans it has served nationwide. The VA Informatics and Computing Infrastructure (VINCI) provides VA research investigators with a nationwide view of high-value VA patient data. Within VA, the Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES) is a consortium of nine sites that are part of an embedded clinical research infrastructure intended to provide systematic site-level solutions to issues that arise during the conduct of VA CSP clinical research. This paper describes the collaboration initiated by the Salt Lake City (SLC) node site to bring informatics and clinical trials together to enhance study planning and recruitment within the VA. Methods The SLC VA Medical Center physically houses both VINCI and a node site and the co-location of these two groups prompted a natural collaboration on both a local and national level. One of the functions of the SLC NODES is to enhance recruitment and promote the success of CSP projects. VINCI supports these efforts by providing VA researchers access to potential population pools. VINCI can provide 1) feasibility data during study planning, and 2) active patient lists during recruitment. The process for CSP study teams to utilize these services involves regulatory documentation, development of queries, revisions to the initial data request, and ongoing communications with several key study personnel including the requesting research team, study statisticians, and VINCI data managers. Results The early efforts of SLC NODES and VINCI aimed to provide patient lists exclusively to the SLC CSP study teams for the following purposes: 1) increasing recruitment for trials that were struggling to meet their respective enrollment goals, and 2) decreasing the time required by study coordinators to complete chart review activities. This effort was expanded to include multiple CSP sites and studies. To date, SLC NODES has facilitated the delivery of these VINCI services to nine active CSP studies. Conclusion The ability of clinical trial study teams to successfully plan and execute their respective trials is contingent upon their proficiency in obtaining data that will help them efficiently and effectively recruit and enroll eligible participants. This collaboration demonstrates that the utilization of a model that partners two distinct entities, with similar objectives, was effective in the provision of feasibility and patient lists to clinical trial study teams and facilitation of clinical trial research within a large, integrated healthcare system.
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Affiliation(s)
- Kandi E Velarde
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Jennifer M Romesser
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Marcus R Johnson
- Durham VA Health Care System, 508 Fulton Street (152), Durham, NC, 27705, USA
| | - Daniel O Clegg
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Olga Efimova
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Steven J Oostema
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Jeffrey S Scehnet
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Scott L DuVall
- VA Salt Lake City Health Care System, 500 Foothill Drive (151), Salt Lake City, UT, 84148, USA
| | - Grant D Huang
- Department of Veterans Affairs, Cooperative Studies Program (10P9CS), 810 Vermont Avenue, NW, Washington, DC, 20420, USA
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9
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Wacher NH, Reyes-Sánchez M, Vargas-Sánchez HR, Gamiochipi-Cano M, Rascón-Pacheco RA, Gómez-Díaz RA, Doubova SV, Valladares-Salgado A, Sánchez-Becerra MC, Méndez-Padrón A, Valdez-González LA, Mondragón-González R, Cruz M, Salinas-Martinez AM, Garza-Sagástegui MG, Hernández-Rubí J, González-Hermosillo A, Borja-Aburto VH. Stepwise strategies to successfully recruit diabetes patients in a large research study in Mexican population. Prim Care Diabetes 2017; 11:297-304. [PMID: 28343902 DOI: 10.1016/j.pcd.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/24/2017] [Accepted: 02/26/2017] [Indexed: 11/24/2022]
Abstract
AIMS Describe stepwise strategies (electronic chart review, patient preselection, call-center, personnel dedicated to recruitment) for the successful recruitment of >5000 type 2 diabetes patients in four months. METHODS Twenty-five family medicine clinics from Mexico City and the State of Mexico participated: 13 usual care, 6 specialized diabetes care and 6 chronic disease care. Appointments were scheduled from 11/3/2015 to 3/31/2016. Phone calls were generated automatically from an electronic database. A telephone questionnaire verified inclusion criteria, and scheduled an appointment, with a daily report of appointments, patient attendance, acceptance rate, and questionnaire completeness. Another recruitment log reviewed samples collected. Absolute number (percentage) of patients are reported. Means and standard deviations were estimated for continuous variables, χ2 test and independent "t" tests were used. OR and 95% CI were estimated. RESULTS 14,358 appointments were scheduled, 9146 (63.7%) attended their appointment: 5710 (62.4%) fulfilled inclusion criteria and 5244 agreed to participate (91.8% acceptance). Those accepting participation were more likely women, younger and with longer disease duration (p<0.05). The cost of the call-center service was $3,010,000.00 Mexican pesos (∼$31.70 USD per recruited patient). CONCLUSIONS Stepwise strategies recruit a high number of patients in a short time. Call centers offer a low cost per patient.
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Affiliation(s)
- Niels H Wacher
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico.
| | - Mario Reyes-Sánchez
- División de Medicina Familiar, Unidad de Atención Primaria, IMSS, Mexico City, Mexico
| | | | - Mireya Gamiochipi-Cano
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | - Rita A Gómez-Díaz
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Svetlana V Doubova
- Unidad de Investigación en Epidemiología y Servicios de Salud, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Adán Valladares-Salgado
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Martha Catalina Sánchez-Becerra
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Araceli Méndez-Padrón
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Leticia A Valdez-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Rafael Mondragón-González
- Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, UMAE Hospital de Especialidades, Centro Médico Siglo XXI, IMSS, Mexico City, Mexico
| | | | | | - Jaime Hernández-Rubí
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arturo González-Hermosillo
- Departamento de Ingeniería en Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Schnurr PP, Chard KM, Ruzek JI, Chow BK, Shih MC, Resick PA, Foa EB, Marx BP, Huang GD, Lu Y. Design of VA Cooperative Study #591: CERV-PTSD, comparative effectiveness research in veterans with PTSD. Contemp Clin Trials 2014; 41:75-84. [PMID: 25457792 DOI: 10.1016/j.cct.2014.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/21/2014] [Accepted: 11/22/2014] [Indexed: 01/04/2023]
Abstract
CERV-PTSD is a randomized controlled trial of two of the most effective treatments for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Despite solid evidence that both treatments are effective, there is limited evidence about their effectiveness relative to one another. The primary objective is to compare the effectiveness of PE and CPT for reducing PTSD symptom severity in a healthcare system that offers both treatments. The secondary objective is to compare the effectiveness of PE and CPT for reducing the severity of comorbid mental health problems and service utilization as well as improving functioning and quality of life. The tertiary objective is to examine whether discrepancy between patient preferences and treatment assignment reduces the effectiveness of each treatment. Exploratory analyses will examine whether demographic and clinical characteristics predict differential response to PE and CPT. The study is designed to randomize 900 male and female veterans with PTSD due to any traumatic military event to receive PE or CPT. The standard dose of treatment is 12 weekly sessions but veterans who improve more rapidly may finish in fewer sessions and veterans who improve more slowly may have additional sessions. The primary outcome is improvement in PTSD symptoms, measured during and after treatment and then 3 and 6 months later. As a large multi-site trial with men and women, CERV-PTSD is designed to advance the delivery of care for PTSD by providing conclusive information about whether one treatment is better than the other, overall, and for different types of patients.
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Affiliation(s)
- Paula P Schnurr
- National Center for PTSD (Executive Division), White River Junction, VT and Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Kathleen M Chard
- Cincinnati VA Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Josef I Ruzek
- National Center for PTSD (Dissemination and Training Division) and Stanford University School of Medicine, Palo Alto, CA, USA
| | - Bruce K Chow
- VA Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Edna B Foa
- University of Pennsylvania, Philadelphia, PA, USA
| | - Brian P Marx
- National Center for PTSD (Behavioral Science Division), Boston University School of Medicine, and VA Boston Healthcare System, Boston, MA, USA
| | - Grant D Huang
- Cooperative Studies Program Central Office, Department of Veterans Affairs Office of Research & Development, Washington, DC, USA
| | - Ying Lu
- VA Cooperative Studies Program Coordinating Center, Palo Alto, CA, USA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
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