Summary

Eligibility
for people ages 18 years and up (full criteria)
Location
at UCSF
Dates
study started
estimated completion
Principal Investigator
Rachel Willard-Grace, MPH (ucsf)
Photo of Rachel Willard-Grace
Rachel Willard-Grace

Description

Summary

The Pulmonary Specialist-Health Coach Consultation (PuSHCon) study examines the implementation of health coach-assisted consultations to improve access to specialist care and implementation of specialist recommendations for patients with COPD, asthma, and asthma COPD overlap syndrome (ACOS) for low-income and vulnerable patients seen at public health clinics. Three hundred sixty (360) patients from ten clinics will be enrolled in the study and randomized at the individual level to receive health coaching or usual care; 180 patients will receive a pulmonary consultation under usual care and 180 patients will receive the PuSHCon model.

Official Title

Pulmonary Specialist-Health Coach Consult (PuSHCon) Model to Improve Access to Specialist Consultation and Receipt of Recommended Evidence-based Care for Vulnerable Patients With Chronic Obstructive Pulmonary Disease (COPD) and Asthma

Details

While evidence-based care for chronic obstructive pulmonary disease (COPD) and asthma can substantially reduce disease burden and prevent emergency visits and hospitalizations, it is estimated that 55% of patients with COPD do not receive all recommended care and that less than 50% of patients with asthma are well controlled.

The proposed study will evaluate the effectiveness of a novel model for pulmonary specialist-health coach consultations (PuSHCon) in its ability to increase access to specialty recommendations and the provision of evidence-based care for patients with chronic obstructive pulmonary disease (COPD) and/or asthma receiving care at federally qualified health centers (FQHCs). The specific aims of the study are to compare the use of evidence-based care and of patient reported outcomes 4 months after the consultation. In addition, the study will evaluate the cost per patient in each model to determine the model's effectiveness in increasing access and lowering cost.

The first aim of comparing the use of evidence-based care will be measured primarily through recommendations for changes in care made by the PSNP, specifically, the proportion of PSNP recommendations that are ultimately received by the patients. The secondary endpoint for this aim will be measured through the proportion of patients receiving guideline-concordant medications at 4 months after consultation compared to baseline.

The second aim of the study regarding patient-reported outcomes will be measured primarily through the change in COPD and/or asthma related quality of life measures from baseline to 4 months post consultation. The secondary measure for this aim will look at changes in COPD and/or asthma specific symptom scores.

The third aim of the study is to assess the impact of this model on access to care and cost of care. Access will be measured by tracking the number of patients who successfully complete a consultation per month. Costs will be determined by calculating time spent per patients (PSNP time versus HC time), as well as by health care utilization.

Keywords

COPD Asthma Health coaching COPD Asthma Access to specialty care PushCon Model

Eligibility

You can join if…

Open to people ages 18 years and up

  • English or Spanish speaking
  • At least 18 years of age
  • Diagnosed with asthma or COPD
  • Experiencing uncontrolled symptoms or exacerbations
  • Referred to see a pulmonary specialist

You CAN'T join if...

  • Do not plan to attend primary care clinic for at least 3 months
  • Already engaged in pulmonary specialty care (defined as at least one visit in last 12 months)
  • Cognitive dysfunction that would prevent interaction with a health coach
  • Not having a phone at which the participant can be reached

Locations

  • Maxine Hall Health Center
    San Francisco California 94115 United States
  • Ocean Park Health Center
    San Francisco California 94122 United States
  • St. Anthony Medical Clinic
    San Francisco California 94102 United States
  • Tom Waddell Urban Health Clinic
    San Francisco California 94102 United States
  • Family Health Center
    San Francisco California 94110 United States
  • Mission Neighborhood Health Center
    San Francisco California 94110 United States
  • Richard H. Fine People's Clinic (General Medicine Clinic)
    San Francisco California 94110 United States
  • Potrero Hill Health Center
    San Francisco California 94107 United States
  • Southeast Health Center
    San Francisco California 94124 United States
  • Silver Avenue Family Health Center
    San Francisco California 94134 United States

Lead Scientist at UC Health

  • Rachel Willard-Grace, MPH (ucsf)
    Rachel Willard-Grace is the Director of the Center for Excellence in Primary Care (CEPC). CEPC identifies, develops, tests, and disseminates promising innovations in primary care to improve the patient experience, enhance population health and health equity, reduce the cost of care, and restore joy and satisfaction in the practice of primary care.

Details

Status
not yet accepting patients
Start Date
Completion Date
(estimated)
Sponsor
University of California, San Francisco
ID
NCT03695276
Study Type
Interventional
Last Updated