Clinician Training Program for Long COVID

Overseen By Shannon Nugent, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Non-VA care, ICU for COVID-19

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

Compensation: Varies

Number of Visits: Unknown

348 Participants Needed

Trial Summary

What is the purpose of this trial?

The evidence-based Concordant Care approach involves engaging in processes that: 1) validate the patient's experience, 2) develop a shared understanding of the condition, and 3) create a patient-centered, whole health-oriented action plan to manage the condition. This is consistent with published expert opinion that Concordant Care underlies patients' (and clinicians') positive experiences of care for poorly understood conditions. Despite strong evidence supporting this care approach, there are no interventions to train clinicians on practices to provide Concordant Care for Veterans with poorly understood conditions such as Long-COVID. Part 1 of the study will optimize and test if a Concordant Care training improves VA clinicians' engagement in recommended practices to provide Concordant Care (i.e., validate, shared understanding, action plan) for Veterans with Long-COVID. This study will adapt and refine Concordant Care training for Long-COVID. Part 2 of this study will determine if Concordant Care training increases clinicians' engagement in recommended practices to provide Concordant Care and will explore the effectiveness of Concordant Care on care outcomes including satisfaction, adherence to care, \& disability for Veterans with Long-COVID. Veterans treated by clinicians receiving Concordant Care training will report their clinician more frequently engaged in recommended conversations (i.e., ask about Long-COVID, validate experience with Long-COVID, create a shared understanding and action plan), and Veterans will perceive greater shared understanding of Long-COVID with their clinicians than Veterans treated by clinicians in the control arm.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems to focus on training clinicians rather than changing participants' medication routines.

What data supports the effectiveness of the treatment Concordant Care Training, Education Packet Training for Long COVID?

The research suggests that clinician training programs, like the Clinical Quality Fellowship Program and palliative care educational initiatives, improve clinicians' skills and lead to better patient care. These programs have shown success in enhancing communication and decision-making skills, which are crucial for aligning medical care with patients' values, similar to the goals of Concordant Care Training. ^{1 2 3 4 5}

How does the Clinician Training Program for Long COVID differ from other treatments for this condition?

The Clinician Training Program for Long COVID is unique because it focuses on educating healthcare providers through a structured training approach, rather than directly treating patients. This program aims to enhance clinicians' understanding and management of Long COVID, which is different from typical medical treatments that involve medications or direct patient interventions. ^{6 7 8 9 10}

Research Team

Lisa Marie McAndrew, PhD

Principal Investigator

East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ

Eligibility Criteria

This trial is for English-speaking VA primary care providers and Veterans with Long-COVID who are receiving care in the VA. Providers must not have prior Concordant Care training, and Veterans need to have an upcoming appointment within 1-6 months after clinician consent.

Inclusion Criteria

Part 2, Veterans must also have a scheduled appointment with one of the participating clinicians within one to six months of the clinician being consented.

Veterans who have Long-COVID symptoms as determined by a specific questionnaire will be included.

I am an English-speaking VA primary care provider.

Exclusion Criteria

Part 1 and Part 2, clinicians who have already taken Concordant Care training will be excluded.

Part 1, Veterans will be excluded if they are not receiving care in the VA.

Part 2, Veterans will be excluded if they were in the Intensive Care Unit (ICU) for COVID-19.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training and Optimization

Part 1 of the study will optimize and test if a Concordant Care training improves VA clinicians' engagement in recommended practices to provide Concordant Care for Veterans with Long-COVID.

Varies

Interviews and focus groups

Randomized Parallel Cluster Trial

Part 2 of the study will determine if Concordant Care training increases clinicians' engagement in recommended practices and explore the effectiveness of Concordant Care on care outcomes.

3 months

Baseline and follow-up assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Treatment Details

Interventions

• Concordant Care Training
• Education Packet Training

Trial Overview The study tests a Concordant Care training program for clinicians treating Long-COVID. It aims to see if this training helps them engage better with patients by validating experiences, understanding conditions together, and planning patient-centered actions.

Participant Groups

Group I: Providers receiving Long-COVID Concordant Care Training Experimental Treatment 1 Intervention

Providers randomized to this arm will receive concordant care training.

Group II: Providers receiving Education Packet Training Active Control 1 Intervention

Providers randomized to this arm will receive education packet training

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

An interdisciplinary educational initiative significantly improved palliative care knowledge and skills among over 1000 clinicians through 27 educational sessions.

The initiative led to measurable increases in palliative care referrals and advanced directive documentation, demonstrating a positive cultural shift in the hospital workforce and earning two national awards for its impact.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transforming the Workforce for Primary Palliative Care Through a System-Wide Educational Initiative. Duty, SM., Loftus, J.[2019]

A study of COVID-19 patients at an academic medical center found that 97% had goals-of-care (GOC) documentation within 48 hours of admission, indicating effective communication and prioritization of patient values during a health crisis.

The use of a structured note template for GOC discussions was beneficial, especially for patients with dementia in nursing facilities, who had timely documentation, while healthier patients experienced delays, highlighting the need for tailored approaches in different patient populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center. Reidy, J., Savageau, JA., Sullivan, K., et al.[2022]

The Clinical Quality Fellowship Program (CQFP) significantly improved quality improvement skills among 87 healthcare professionals in New York, with participants reporting enhanced abilities across all assessed areas after completing the program.

Over half (56%) of the participants received promotions after finishing the CQFP, indicating that the program not only fostered skill development but also positively impacted career advancement in the healthcare field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Clinical Quality Fellowship Program: Developing Clinical Quality Leadership in the Greater New York Region. Bhalla, R., Jalon, HS., Ryan, L.[2019]

In response to the COVID-19 pandemic, a Palliative Care Toolkit was developed to support nonpalliative care clinicians in managing symptoms like dyspnea and delirium, providing evidence-based guidance and resources for effective patient care.

The Toolkit has successfully increased the acceptance of palliative care practices among hospital staff, allowing specialized teams to focus on the most critical cases while ensuring broader access to essential palliative care resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Palliative Care Toolkit for the COVID-19 Pandemic. deLima Thomas, J., Leiter, RE., Abrahm, JL., et al.[2021]

The Center to Advance Palliative Care (CAPC) clinical curriculum, launched in 2015, has trained over 26,000 clinicians in essential skills for managing serious illness, with a significant portion being registered nurses and advanced practice providers.

Post-course evaluations showed that 84% of participants intended to change their practice based on the training, indicating the curriculum's effectiveness in enhancing care quality for patients with serious illness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of an Online Palliative Care Clinical Curriculum to Train U.S. Hospital Staff: 2015-2019. Rogers, MM., Chambers, B., Esch, A., et al.[2021]

The Duke-Watts Family Medicine Program successfully integrated geriatric medicine training into its residency program by involving residents in the planning process and focusing on practical, relevant goals.

Key strategies included developing a conference series, identifying training sites, and incorporating various healthcare professionals, which enhanced the training experience across different care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Geriatric training in family medicine: the natural history of a developing program. Moore, JT., Kane, WJ.[2004]

The small-group airway skills workshops for experienced clinicians were successfully implemented during the clinical workday, with 47 anesthesiologists and 17 CRNAs participating, demonstrating feasibility and high acceptability among attendees.

While the workshops did not significantly increase participants' confidence in airway management skills, they received positive feedback, indicating that this flexible training approach can effectively complement traditional large-format educational methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians. Daly Guris, RJ., Toy, S., Bruins, BB., et al.[2022]

The COVID-19 Clinical Rounds Initiative, developed by the US Department of Health and Human Services and the University of New Mexico, created a large-scale peer-to-peer learning network to enhance clinical education during the pandemic, engaging participants from all 50 states and over 100 countries.

Between March 2020 and February 2021, the initiative conducted 125 learning sessions, providing more than 58,000 hours of educational contact, focusing on critical areas of COVID-19 care such as emergency medical services, emergency departments, and inpatient critical care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Peer-to-Peer Learning to Enhance and Accelerate the Health System Response to COVID-19: The HHS ASPR Project ECHO COVID-19 Clinical Rounds Initiative. Hunt, RC., Struminger, BB., Redd, JT., et al.[2022]

An outpatient telehealth program was successfully implemented to monitor 296 patients diagnosed with COVID-19, with over 800 phone calls made during the 8-month study, demonstrating the feasibility of remote patient care during the pandemic.

The program involved 30 medical student volunteers and ensured continued access to care, with only four patient deaths reported, indicating a potentially effective approach to managing COVID-19 patients at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

COVID-19 Home Monitoring: An Institutional Approach to Bridging Care During a Pandemic. Wong, GJ., Douglas, K., Fuest, S., et al.[2022]

A rapid training program for contact tracing and case investigation was developed and successfully scaled, training 7,499 individuals in California from April to August 2020, demonstrating the feasibility of quickly mobilizing a workforce to combat COVID-19.

The training emphasized interactive, skills-based learning, particularly in rapport building and health coaching, which are crucial for effective case investigation and contact tracing, highlighting the importance of practical training and feedback in public health education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

California's COVID-19 Virtual Training Academy: Rapid Scale-Up of a Statewide Contact Tracing and Case Investigation Workforce Training Program. Brickley, DB., Forster, M., Alonis, A., et al.[2021]

References

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

Transforming the Workforce for Primary Palliative Care Through a System-Wide Educational Initiative. [2019]

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

Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

The Clinical Quality Fellowship Program: Developing Clinical Quality Leadership in the Greater New York Region. [2019]

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

Development of a Palliative Care Toolkit for the COVID-19 Pandemic. [2021]

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

Use of an Online Palliative Care Clinical Curriculum to Train U.S. Hospital Staff: 2015-2019. [2021]

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

Geriatric training in family medicine: the natural history of a developing program. [2004]

7. France pubmed.ncbi.nlm.nih.gov

Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians. [2022]

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

Virtual Peer-to-Peer Learning to Enhance and Accelerate the Health System Response to COVID-19: The HHS ASPR Project ECHO COVID-19 Clinical Rounds Initiative. [2022]

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

COVID-19 Home Monitoring: An Institutional Approach to Bridging Care During a Pandemic. [2022]

10. Switzerland pubmed.ncbi.nlm.nih.gov

California's COVID-19 Virtual Training Academy: Rapid Scale-Up of a Statewide Contact Tracing and Case Investigation Workforce Training Program. [2021]