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

800 Participants Needed

Trial Summary

What is the purpose of this trial?

This is a randomized controlled trial of the Patient-Initiated Note about Goals (PING).

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 safety data exists for PING in chronic disease management?

The provided research does not contain specific safety data for PING or Patient-Initiated Note about Goals. The studies focus on communication practices, patient engagement, and the use of health information technology, but do not directly address safety data for PING. ^{1 2 3 4 5}

Is the treatment in the PING for Chronic Disease Management trial a promising treatment?

Yes, the treatment is promising because it helps patients and doctors communicate better, makes patients feel more prepared for their visits, and improves the quality of care for chronic diseases. ^{6 7 8 9 10}

How is the PING treatment for chronic disease management different from other treatments?

The PING treatment is unique because it uses a personal health record system that allows patients and their healthcare providers to share medical records and decision support tools online, which can improve communication and the quality of routine care. ^{6 7 8 9 10}

What data supports the idea that PING for Chronic Disease Management is an effective treatment?

The available research does not provide direct evidence about the effectiveness of PING for Chronic Disease Management. However, it suggests that increasing patient involvement in their own care, such as through personalized health records, can improve the receipt of recommended services for chronic conditions. This implies that treatments like PING, which encourage patient participation, might be beneficial. Unfortunately, there is no specific data comparing PING to other treatments for chronic disease management in the provided information. ^{1 5 11 12 13}

What data supports the effectiveness of the treatment Patient-Initiated Note about Goals (PING) for chronic disease management?

Research suggests that increasing patients' involvement in their own care, such as through personalized health records, can improve the receipt of recommended services for chronic conditions. This implies that treatments like PING, which encourage patient participation, may be effective in managing chronic diseases. ^{1 5 11 12 13}

Research Team

David J Casarett, MD

Principal Investigator

Duke Health

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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 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]

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 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]

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]

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 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]

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]

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

How well do documented goals-of-care discussions for patients with stage IV cancer reflect communication best practices? [2021]

2. England 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. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Patterns of response to patient-centered decision support through a personal health record. [2021]

4. Ireland pubmed.ncbi.nlm.nih.gov

Physicians' perceptions about narrative note sections format and content: A multi-specialty survey. [2021]

5. Ireland pubmed.ncbi.nlm.nih.gov

Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. [2023]

6. England 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. [2021]

7. England 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. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Using Health Information Technology to Foster Engagement: Patients' Experiences with an Active Patient Health Record. [2023]

9. Netherlands 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. [2008]

10. United States pubmed.ncbi.nlm.nih.gov

People with diabetes who read their clinicians' visit notes: Behaviors and attitudes. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. [2021]

12. Canada pubmed.ncbi.nlm.nih.gov

The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study. [2021]

13. United States pubmed.ncbi.nlm.nih.gov

Health coaching via an internet portal for primary care patients with chronic conditions: a randomized controlled trial. [2019]