Participant and Research Team Perspectives on the Conduct of a Remote Therapeutic COVID-19 Clinical Trial: A Mixed Methods Approach

Evaluation of an Outpatient Research Facility Telehealth Program

Chronic diseases globally contribute to heightened rates of morbidity and mortality. Telehealth is a viable approach to managing chronic illness. In response to the coronavirus pandemic, a research facility implemented telehealth in April 2020 to continue research activities. A telehealth program evaluation was needed to explore the facility's strengths and improvement opportunities. The Centers for Disease Control and Prevention's Framework for Program Evaluation guided the evaluation to determine whether telehealth implementation improved care access, efficiency, and provider experiences. Missed and canceled visits, visit duration, and wait times between April 2020 and June 2023 were analyzed for those 19 years and older with chronic illnesses identified by International Classification of Diseases, 10th Revision codes. Provider experiences were measured with the Telehealth Usability Questionnaire. The facility transitioned from Microsoft Teams® to a telehealth platform in March 2023, offering more robust data. Analyses revealed improved completed visits, decreased patient abandoned visits, and varied canceled and duration percentages. Providers missed visits less frequently than patients. Run charts for telehealth total visits versus chronic visits did not reveal special cause variations. Provider experiences were favorable except for telehealth reliability and interface quality. Recommendations include continued user training, evaluating patients' experiences, exploring telehealth's impact on research participant recruitment, and standardizing evaluation processes through policy development.

Disparities in Race and Ethnicity Reporting and Representation for Clinical Trials in Stroke: 2010 to 2020

BACKGROUND

Racial and ethnic minority groups are at a higher stroke risk and have poor poststroke outcomes. The aim of this study was to assess the frequency of race reporting and proportions of race and ethnicity representation in stroke-related clinical trials.

METHODS AND RESULTS

This is a descriptive study of stroke-related clinical trials completed between January 1, 2010 and December 31, 2020, and registered on ClinicalTrials.gov. Trials conducted in the United States, related to stroke and enrolling participants ≥18 years, were considered eligible. Trials were reviewed for availability of published results, data on race and ethnicity distribution, and trial characteristics. Overall, 60.1% of published trials reported race or ethnicity of participants, with a 2.6-fold increase in reporting between 2010 and 2020. White patients represented 65.0% of the participants, followed by 24.8% Black, 2.4% Asian or Pacific Islander, and <1% Native American and multiracial participants; 9.0% were of Hispanic ethnicity. These trends remained consistent throughout the study period, except in 2018, when a higher proportion of Black participants (53.1%) was enrolled compared with White participants (35.8%). Trials with the National Institutes of Health/federal funding had higher enrollment of Black (28.1%) and Hispanic (13.8%) participants compared with other funding sources. Behavioral intervention trials had the most diverse enrollment with equal enrollment of Black and White participants (41.1%) and 14.5% Hispanic participants.

CONCLUSIONS

Despite the increase in race and ethnicity reporting between 2010 and 2020, the representation of racial and ethnic minority groups remains low in stroke trials. Funding initiatives may influence diversity efforts in trial enrollment.

Narrative review of telemedicine applications in decentralized research

Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.

From a decentralized clinical trial to a decentralized and clinical-trial-in-a-box platform: Towards patient-centric and equitable trials

Background/Objective

Despite the intuitive attractiveness of bringing research to participants rather than making them come to central study sites, widespread decentralized enrollment has not been common in clinical trials.

Methods

The need for clinical research in the context of the COVID-19 pandemic, along with innovations in technology, led us to use a decentralized trial approach in our Phase 2 COVID-19 trial. We used real-time acquisition and transmission of health-related data using home-based monitoring devices and mobile applications to assess outcomes. This approach not only avoids spreading COVID-19 but it also can support inclusion of participants in more diverse socioeconomic circumstances and in rural settings.

Results

Our team developed and deployed a decentralized trial platform to support patient engagement and adverse event reporting. Clinicians, engineers, and informaticians on our research team developed a Clinical-Trial-in-a-Box tool to optimally collect and analyze data from multiple decentralized platforms.

Conclusion

Applying the decentralized model in Long COVID, using digital health technology and personal devices integrated with our telehealth platform, we share the lessons learned from our work, along with challenges and future possibilities.