PING for Chronic Disease Management

(PING Trial)

Overseen By David J Casarett, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Duke University

Disqualifiers: Non-English speaking

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 2 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new approach called Patient-Initiated Note about Goals (PING) to help manage chronic diseases. The researchers aim to determine if patients who actively communicate their health goals with nurses can improve their overall care. Participants will either use PING or receive their usual care. Those scheduled for an Annual Wellness Visit at one of the participating clinics and who speak English might be suitable for the trial. As an unphased study, this trial offers a unique opportunity to actively participate in enhancing the healthcare experience.

Do I need to stop my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Do I need to stop taking my current medications for the PING trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that the Patient-Initiated Note about Goals (PING) is safe for chronic disease management?

Research has shown that the Patient-Initiated Note about Goals (PING) helps patients share their care goals through electronic health records. Specific safety information about PING for managing chronic diseases is currently unavailable. However, as a communication tool rather than a medication or surgery, PING likely poses a low risk of physical side effects or health issues.

The trial phase is labeled "Not Applicable," indicating that the tool isn't a traditional drug or treatment with major safety concerns. This suggests that PING is considered safe enough to test without the initial safety phases typically required for new drugs or devices. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about PING for chronic disease management because it empowers patients by allowing them to actively participate in setting and communicating their health goals. Unlike traditional treatments that primarily focus on clinical interventions by healthcare providers, PING offers a unique approach where patients take the initiative to document and share their personal health objectives with their care team. This patient-centered method can lead to more personalized care and potentially improve patient engagement and outcomes. By shifting the focus to what matters most to patients, PING hopes to enhance the effectiveness of chronic disease management.

What evidence suggests that the Patient-Initiated Note about Goals (PING) is effective for chronic disease management?

Research has shown that the Patient-Initiated Note about Goals (PING), which participants in this trial may receive, helps guide care by aligning it with patient preferences. Studies indicate that patients using PING can set clear goals and plan for managing chronic diseases. This tool encourages conversations between patients and healthcare providers about care preferences. Additionally, PING has shown promise in helping patients manage their health conditions by focusing on what matters most to them. It uses digital technologies to boost patient motivation and improve self-care for chronic illnesses. ^{1 2 3 6 7}

Who Is on the Research Team?

David J Casarett, MD

Principal Investigator

Duke Health

Are You a Good Fit for This Trial?

This trial is for patients who have been referred for an Annual Wellness Visit at a participating clinic. It's specifically designed for English-speaking individuals, as non-English speakers are not eligible to participate.

Inclusion Criteria

Patient referred for Annual Wellness Visit at participating clinic

Exclusion Criteria

Non-English speaking

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the Patient-Initiated Note about Goals (PING) administered by a registered nurse or usual care

2 months

Follow-up

Participants are monitored for subsequent goals of care conversations and healthcare utilization

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Patient-Initiated Note about Goals (PING)

Trial Overview The study is examining the effectiveness of a Patient-Initiated Note about Goals (PING) in managing chronic diseases. This randomized controlled trial will compare outcomes between those using PING and those who do not.

How Is the Trial Designed?

Group I: Treatment Experimental Treatment 1 Intervention

Patients receive PING administered by RN

Group II: Control Active Control 1 Intervention

Usual care

Who Is Running the Clinical Trial?

Duke University

Lead Sponsor

Trials

2,495

Recruited

5,912,000+

Published Research Related to This Trial

Only 42% of hospitalized patients with Stage IV cancer had documented goals-of-care discussions in their electronic health records, with a strong focus on treatment options but limited communication about prognosis.

Using templated notes significantly improved the documentation of patients' goals and values (80% vs. 61%), suggesting that structured communication can enhance the quality of EHR documentation in goal-concordant care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices? Ernecoff, NC., Wessell, KL., Wood, WA., et al.[2021]

A survey of 88 outpatient physicians revealed that the preferred format for the history of present illness (HPI) is a coherent story, while a categorized list is favored for the assessment and plan (AP), indicating a need for tailored documentation styles in electronic health records (EHRs).

Physicians identified key content preferences, with temporal information and findings being most relevant in HPI, and interventions and justifications in AP, highlighting the importance of relevant and concise information in clinical documentation to enhance usability and efficiency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physicians' perceptions about narrative note sections format and content: A multi-specialty survey. Colicchio, TK., Dissanayake, PI., Cimino, JJ.[2021]

Patients and clinicians find electronic health record (EHR)-generated after-visit summaries (AVSs) valuable for summarizing health visits, but both groups suggest improvements in content organization and clarity, such as preferring a single 'current' medication list.

Concerns about patient privacy and clinician workflow challenges were highlighted, indicating that while AVSs are useful, their effectiveness can be hindered by these issues, suggesting a need for collaboration between EHR vendors and stakeholders to enhance their utility.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design. Federman, AD., Sanchez-Munoz, A., Jandorf, L., et al.[2022]

The health maintenance module within a personal health record has been positively received by both patients and providers, indicating strong acceptance of this online tool for sharing medical information.

Preliminary results suggest that this module can enhance communication between patients and providers, potentially leading to improved quality in routine preventive care, though further research is needed to assess its long-term effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Empowering patients to improve the quality of their care: design and implementation of a shared health maintenance module in a US integrated healthcare delivery network. Poon, EG., Wald, J., Schnipper, JL., et al.[2008]

The OurDX online tool successfully engaged patients and families in the diagnostic process, with 39% of eligible pediatric visits and 65% of adult visits utilizing the tool, leading to the identification of diagnostic safety opportunities (DSOs) in 63% of reported concerns.

Most clinician notes incorporated patient and family contributions, indicating that their input on visit priorities and medical histories was effectively integrated into the healthcare process, enhancing communication and potentially improving diagnostic safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool. Bell, SK., Dong, ZJ., Desroches, CM., et al.[2023]

A randomized trial involving 241 patients tested an internet portal-based coaching intervention, which led to more patients receiving specific health advice (94% vs. 84%) and referrals to specialists (51% vs. 28%) compared to a control group.

Despite these improvements in communication and advice from primary care physicians, the intervention did not significantly change the detection or management of chronic conditions, nor did it impact overall patient outcomes, suggesting that further research is needed to enhance the effectiveness of such interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health coaching via an internet portal for primary care patients with chronic conditions: a randomized controlled trial. Leveille, SG., Huang, A., Tsai, SB., et al.[2019]

In a study involving 584 participants at high risk for cardiovascular disease, 86% responded to notifications about preventive healthcare services through a personalized health record (PHR), leading to a significant engagement in their care.

The intervention resulted in the closure of 58% of the 2,656 identified prevention gaps over one year, demonstrating that PHR notifications can effectively encourage patients to take action on their healthcare needs without causing alert fatigue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patterns of response to patient-centered decision support through a personal health record. Hess, R., Fischer, GS., Sullivan, SM., et al.[2021]

A survey of 6,913 patients revealed that less educated and nonwhite patients found clinicians' visit notes extremely important for understanding their care, with 74% of patients with ≤high school education and 70.7% of black patients emphasizing their importance.

Less educated patients were nearly three times more likely to rate the notes as extremely important for engaging in their care compared to more educated patients, highlighting the potential of transparent notes to improve healthcare engagement among vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study. Gerard, M., Chimowitz, H., Fossa, A., et al.[2021]

Sharing clinic notes with patients who have COPD enhances communication and self-management by providing them with important details about their condition and encouraging them to seek more information.

Patients responded positively to notes that reflected their concerns and experiences, but negatively to complex medical jargon and inaccuracies, highlighting the need for patient-centered language in clinical documentation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. Fisher, KA., Kennedy, K., Bloomstone, S., et al.[2023]

A survey of 2104 adults with diabetes showed that they read an average of 59% of their available clinical notes, indicating a strong interest in understanding their health information.

Over 90% of patients reported that they understood their clinicians' notes well, and 73-80% considered reading these notes extremely important for managing their health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

People with diabetes who read their clinicians' visit notes: Behaviors and attitudes. Dong, Z., Leveille, S., Lewis, D., et al.[2023]

A survey of 332 adolescents and young adults (AYA) and 6,914 adults showed that over 85% of both groups read at least one electronic visit note in the past year, indicating high engagement with open notes.

AYA reported similar benefits from reading their medical notes as adults, suggesting that open notes can effectively involve young patients in their healthcare and improve their understanding and safety behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attitudes, experiences, and safety behaviours of adolescents and young adults who read visit notes: Opportunities to engage patients early in their care. Lam, BD., Bourgeois, F., DesRoches, CM., et al.[2021]

Patients using the active Personal Health Record (PHR) called HealthTrak reported improved communication with their healthcare providers, which can enhance the overall quality of care.

The active PHR encouraged patients to take a more proactive role in managing their health, fostering a partnership with providers and potentially leading to better health outcomes, especially for those at risk for cardiovascular disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Health Information Technology to Foster Engagement: Patients' Experiences with an Active Patient Health Record. Rief, JJ., Hamm, ME., Zickmund, SL., et al.[2023]

The use of a previsit electronic journal for patients with Type 2 diabetes significantly improved their preparation for primary care visits, with 60% of participants feeling more prepared and 53% providing more accurate information to their healthcare providers.

Creating a diabetes care plan through the journal took patients an average of 5-9 minutes, indicating that this tool is efficient and could enhance the overall patient experience, despite the study's limitations in participant diversity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. Wald, JS., Grant, RW., Schnipper, JL., et al.[2021]

Citations

1. dihi.org dihi.org/project/patient-initiated-note-about-goals-ping/

Patient Initiated Note about Goals (PING) A patient-initiated survey on goals in the electronic health record is feasible and can guide goal-concordant care.

2. withpower.com withpower.com/trial/phase-chronic-disease-1-2022-46591

PING for Chronic Disease Management · Info for Participants Trial Overview The study is examining the effectiveness of a Patient-Initiated Note about Goals (PING) in managing chronic diseases. This randomized controlled ...

3. trial.medpath.com trial.medpath.com/clinical-trial/e9d5b32e9216df2f/nct05637489-patient-initiated-note-goals

Patient Initiated Note About Goals | MedPath Outcomes include PING completion, subsequent goals of care conversations with providers, and healthcare utilization. Subscribe. Study Timeline.

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5437864/

Decision-making and goal-setting in chronic disease ... High-risk, low-SES patients identified high priority conditions, set ambitious goals and generate individualized action plans for chronic disease management.

5. nature.com nature.com/articles/s44401-025-00017-4

A systematic review of strategies in digital technologies for ... This systematic review investigates the motivational strategies within digital technologies to improve self-care adherence for chronic illnesses.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8459217/

The Impact of Digital Patient Portals on Health Outcomes ... The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency.

7. jpsmjournal.com jpsmjournal.com/article/S0885-3924(22)00973-3/fulltext

Predictors of Documented Goals-of-Care Discussion for ... Of 16,262 consecutive, eligible patients without missing data, 5,918 (36.4%) had a documented goals-of-care discussion during hospitalization; ...