Trial document



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  DRKS00019219

Trial Description

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Title

Cooperation networks of ambulatory healthcare providers: exploration of mechanisms that influence coordination of care

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Trial Acronym

ExKoCare

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URL of the Trial

http://www.exko.care

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Brief Summary in Lay Language

More and more patients need treatment by several physicians at once. This trend needs to be taken into account by implementation sciences: If recommended practices need to be implemented by physicians and other care providers, close cooperation and coordination is necessary.

The purpose of this study is to examine this coordination, based on two research questions:

a) Which differences are there regarding cooperation and coordination between various providers of care?

b) Which factors are relevant for the coordination and implementation of recommended practices?

Two study phases are planned:

1) Written questionnaires for 600 chronically ill patients (with at least one chronic cardiovascular disease) from 40 general practitioners' practices and up to 320 care providers (general practitioners, practice assistants and cardiologists).

2) Telephone interviews with a total of 80 general practitioners, practice assistants and patients. Additionally, focus group interviews with 10 to 15 stakeholders and experts in health care.

The study aims at discovering which factors influence coordination of care and the implementation of recommended practices. In the future, this can make coordination of care providers measurable and serve the purpose of developing improvements in health care.

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Brief Summary in Scientific Language

Due to increasing numbers of patients with complex chronic health problems and ongoing specialisation in healthcare delivery, implementation science needs to take into account that many patients receive healthcare from different healthcare providers. Based on a social networks perspective, this project explores which mechanisms contribute to coordination of healthcare and the implementation of recommended practices, considering both the provider and the patient views on cooperation networks.

The project aims a) to describe and explore variation in professional networks from the perspective of patients and providers and b) to explore which network-related mechanisms play a role in coordination and the uptake of recommended practices.

Hypothesised network-related mechanisms relate to opinion leaders, central care providers, network density, network homogeneity, case coordination, network reciprocity, and change of network composition.

Two consecutive studies are planned in real-world settings:

1) An observational study of healthcare provider networks, involving 600 patients with chronic (ateriosclerosis-related) cardiovascular disease from 40 general practices and up to 320 healthcare providers in total.

2) Qualitative interview study with 80 healthcare providers and patients, and a focus groups study with 10-15 stakeholders and experts, which are both focused on identifying network-related mechanisms.

Additionally, an analysis of claims data regarding coordination of health care is planned. Furthermore, methodologically a variation of initial invitation letters is planned to analyze possible effects of invitation letters on participation rates among general practices.

The project will provide knowledge on mechanisms, which underlie coordination of healthcare and uptake of recommended practices. This will contribute to the design of innovative strategies for improving health care practice and to the development of measures of provider-networks, which can be used in future research.

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Do you plan to share individual participant data with other researchers?

[---]*

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Description IPD sharing plan:

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Organizational Data

  •   DRKS00019219
  •   2019/11/07
  •   [---]*
  •   yes
  •   Approved
  •   S-726/2018, Ethik-Kommission I der Medizinischen Fakultät Heidelberg
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Secondary IDs

  • [---]*
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Health Condition or Problem studied

  •   Coordination of care between care providers
  •   Chronic ateriosclerotic/cardiovascular dieases
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Interventions/Observational Groups

  •   Study 1:

    - All practice owners will receive a written questionnaire to provide basic information on their practice.

    - All general practitioners will receive a written questionnaire on cooperation and coordination within their practice and between their practice and other health care providers.

    - In each practice, one general practitioner will be interviewed via telephone on cooperation and coordination withing their practice and between their practice and other health care providers.

    - All practice assistants will receive a written questionnaire on cooperation and coordination withing their practice and between their practice and other health care providers.

    - All patients will receive a written questionnaire on cooperation and coordination within their general practitioner's practice and the cooperation and coordination between their general practitioner's practice and other health care providers.

    Study 2:

    - In 8 practices, a general practitioner (not the one interviewed in study 1 if this is possible) and one physician's assistant as well as 3 patient will be interviewed via telephone in depth on cooperation and coordination within the general practitioner's practice and cooperation and coordination between the general practitioner's practice and other health care providers.

    - 10-15 stakeholders will be interviewed through focus groups on cooperation and coordination within general practitioners' practices and between general practitioners' practices and medical specialist's practices in health care.

    Additionally, an analysis of claims data regarding coordination of health care is planned.
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Characteristics

  •   Non-interventional
  •   Observational study
  •   Single arm study
  •   Open (masking not used)
  •   [---]*
  •   Uncontrolled/Single arm
  •   Health care system
  •   Single (group)
  •   N/A
  •   N/A
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Primary Outcome

Coordination of health care from the patients' perspectives

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Secondary Outcome

- Cooperation networks of health care providers

- Claims-data based measures of coordination of health care

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • Doctor's Practice 
  • Doctor's Practice 
  • Doctor's Practice 
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Recruitment

  •   Actual
  •   2019/11/14
  •   1000
  •   Monocenter trial
  •   National
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Inclusion Criteria

  •   Both, male and female
  •   18   Years
  •   no maximum age
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Additional Inclusion Criteria

- General practitioner's practices: Registered/located in Baden-Württemberg, Rhineland-Palatinate or Saarland.

- General practitioners: Being of legal age and able to consent.

- Practice assistants: Being of legal age and able to consent.

- Patients: Having at least 3 chronic medical, cardiovascular conditions (one of them based on atherosclerosis), being of legal age and able to consent.

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Exclusion Criteria

- General practitioner's practices: Registered/located outside of Baden-Württemberg, Rhineland-Palatinate or Saarland.

- General practitioners: Not being of legal age and/or not being able to consent.

- Practice assistants: Not being of legal age and/or not being able to consent.

- Patients: Having not at least 3 chronic medical conditions and/or none of them being based on atherosclerosis/being cardiovascular and/or not being of legal age and/or not being able to consent.

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Addresses

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    • Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung
    • Mr.  Prof. Dr.  Michel  Wensing 
    • Im Neuenheimer Feld 130.3, Turm West
    • 69120  Heidelberg
    • Germany
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    • Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung
    • Mr.  Prof. Dr.  Michel  Wensing 
    • Im Neuenheimer Feld 130.3, Turm West
    • 69120  Heidelberg
    • Germany
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    • Universitätsklinikum HeidelbergAbteilung Allgemeinmedizin und Versorgungsforschung
    • Ms.  Christine  Arnold 
    • Im Neuenheimer Feld 130.3
    • 69120  Heidelberg
    • Germany
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    • Universitätsklinikum Heidelberg, Abt. Allgemeinmedizin und Versorgungsforschung
    • Mr.  Patrick  Hennrich 
    • Im Neuenheimer Feld 130.3, Turm West
    • 69120  Heidelberg
    • Germany
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Sources of Monetary or Material Support

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    • Deutsche Forschungsgemeinschaft
    • Kennedyallee 40
    • 53175  Bonn
    • Germany
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Status

  •   Enrolling by invitation
  •   [---]*
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Trial Publications, Results and other Documents

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* This entry means the parameter is not applicable or has not been set.