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Integrated Caree-Spiro-HC3NCT02592928

Regional Implementation of Collaborative Lung Function Testing

An observational study of Integrated Care and Telehealth, run by Hospital Clinic of Barcelona at 1 site in Spain.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Background/Aims There is evidence indicating that deployment of forced spirometry (FS) testing in a collaborative scenario, encompassing respiratory specialists and community professionals, generates healthcare efficiencies. Read more about this study

Who is it for?
Any age
Conditions the study is for
Integrated Care, Telehealth, Health Care Rationing
What is being tested?
Inclusion of Spirometry into the Electronic Health Records
How many people
300 participants
Where
1 siteSpain
Study dates
1 Mar 2019to 20 Dec 2019
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: The initial 6 months will include 3 healthcare sectors: Lleida (168k inhabitants, 21 Primary Care Centers), Vic (49k inhabitants, 11 PCC), and AISBE (540k inhabitants, 19 PCC) following a Plan-Do-Study-Act (PDSA) methodology. The first PDSA cycle (January - March 2016) including a total of 3 PCC, one in each healthcare sector, has as main purpose to ensure full functionality of the setting. The FS program will be progressively deployed to all PCC in the 3 sectors in a second 3-months PDSA cycle that will be completed by mid-2016. FS testing will be prescribed by general practitioner following standard criteria and it will be carried out by primary care nurses. The deployment in the entire region (7.5M inhabitants and 369 Primary Care centers) will be completed within 2016.

Who may be able to join

  • All patients included in the regular practice

Who cannot join

  • Clinical an Medical exclusion criteria as the forced spirometry standards recommend.

Trial locations and contacts

1 site in 1 country.

Spain1 site, 1 recruiting
  • Felip Burgos

    Barcelona, 08036

    Felip Burgos, PhD, RN, 34932275540, fburgos@ub.edu

    Recruiting

Other trials in Spain

About this study

Background/Aims There is evidence indicating that deployment of forced spirometry (FS) testing in a collaborative scenario, encompassing respiratory specialists and community professionals, generates healthcare efficiencies. The study describes the roadmap for regional implementation of the FS program in Catalonia (ES), from January to December 2016.

Methods/Design Firstly, the FS program will be deployed in three healthcare sectors (514 k inhabitants), following Plan-Do-Study-Act iterative cycles, using the Model for Assessment of Telemedicine for evaluation purposes. Thereafter, regional deployment of the FS program (7.5M inhabitants) will be conducted. The third step considers: evaluation of transferability, preparation for data analytics and recommendations for long-term assessment of outcomes. Main components of the FS program are: i) Automatic quality testing; ii) Standardized data transfer to a shared electronic health record; iii) Elaboration of individual FS reports including historical results; and, iv) Clinical decision support systems providing access to the FS report, and to remote support upon request.

Discussion/Conclusions The project constitutes the first attempt to scale-up a collaborative scenario for FS testing that will open new avenues for longitudinal lung function assessment. Moreover, the setting shows high potential for transferability to different sites and to other diagnostic procedures.

Read the detailed description

The Forced Spirometry program emerges from a series of studies reporting on technological solutions for each of the main components indicating the potential of their articulated application aiming at covering unmet needs for collaborative FS testing. The studies were initiated within the EU project NEXES22;23 and specific parts of the overall setting have already been successfully evaluated in the Basque Country.

The setting \& Study design The current protocol has been designed as part of the regional deployment of integrated care services in Catalonia. It consists of the two lines of activity ultimately aiming at: i) regional adoption of the FS program; and, ii) generalization of the approach to other areas, as well as to other testing procedures. The research was submitted and apoved by the Ethical Committee of the Hospital Clínic i Provincial de Barcelona.

Program deployment The initial 6 months will include three healthcare sectors: Lleida (168k inhabitants and 21 Primary Care centers), Vic (49k inhabitants and 11 PCC), and Atenció Integral en Salut Barcelona Esquerra (AISBE) (540k inhabitants and 19 PCC) following a Plan-Do-Study-Act (PDSA) methodology24. The first PDSA cycle (January - March 2016) including a total of three primary care centers, one in each healthcare sector, has as main purpose to ensure full functionality of the setting. Immediately thereafter, the FS program will be progressively deployed to all Primary Care centers in the three sectors in a second 3-months PDSA cycle that will be completed by mid-2016. Forced spirometry testing will be prescribed by the attending general practitioner following standard criteria and it will be carried out by primary care nurses.

The deployment of the program in the entire region (7.5M inhabitants and 369 Primary Care centers) will be completed with no discontinuation within 2016. It will follow identical PDSA methodology. The outcomes of the assessment carried out during each PDSA cycle will modulate the long-term assessment strategy of the FS program described below.

Being tested
Inclusion of Spirometry into the Electronic Health Records
Keywords
eHealth, Spirometry, Lung Function, Primary Care, Telehealth, Integrated Care

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Inclusion of Spirometry into the Electronic Health RecordsOther

    Also called Follow up using Plan-Do-Study-Act (PDSA) methodology

    Inclusion of the Forced Spirometry into the Electronic Health Records

Study groups in NCT02592928
Study groupRoleWhat they receive
Lleida Health SectorLleida (168k inhabitants and 21 Primary Care centers). Primary Care centers from this health sector Inclusion of the Forced Spirometry into the Electronic Health Records No interventions performed
Receives: Other: Inclusion of Spirometry into the Electronic Health Records
Vic Health SectorVic (49k inhabitants and 11 Primary Care Centers). Primary Care centers from this health sector Inclusion of the Forced Spirometry into the Electronic Health Records No interventions performed
Receives: Other: Inclusion of Spirometry into the Electronic Health Records
AISBE Health SectorAtenció Integral en Salut Barcelona Esquerra (AISBE) (540k inhabitants and 19 Primary Care centers). Primary Care centers from this health sector Inclusion of the Forced Spirometry into the Electronic Health Records No interventions performed
Receives: Other: Inclusion of Spirometry into the Electronic Health Records

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Primary Care Centers (PCC) and professionals involved in the territory using the Electronic Health Records (EHR)

    Number of PCC exporting both the raw spirometric data, including all FS curves, and the FS report to the shared electronic health record at a regional level.

    Measured: Thought study completition in average of 18 months

  2. Number of professionals using Forced Spirometry included in the EHR (percentage per PCC)

    Number of professionals with accessi of the FS testing report, irrespective of the healthcare provider and health level wherein testing was performed

    Measured: Thought study completition in average of 18 months

  3. Change between inicial and end of the project (number of FS test included in the EHR)

    Measured: Thought study completition in average of 18 months

Secondary outcomes (9)
  1. Forced Spirometry Parameters

    • Measured in liters

    Measured: Thought study completition in average of 18 months

  2. Grade of quality in relation of total Forced Spirometry

    Percentage of patients with FS grade of quality (A-B-C-D-F) in relation of total FS

    Measured: Thought study completition in average of 18 months

  3. Change from baseline in relations with ascertainment of COPD or Asthma diagnosis

    • Percentage of patients with FEV1/FVC ratio < 0.7 and without diagnosis of Asthma and COPD
    • Percentage of patients with FEV1/FVC ratio > 0.7 and with diagnosis Asthma and COPD
    • Percentage of patients with restrictive pattern and FEV1/FVC ratio < 0.7

    Measured: Thought study completition in average of 18 months

  4. Number of participants per PCC

    Long-term benefits from data analytics of longitudinal information

    Assessments using unique measurements

    Measured: Through study completion, an average of 18 months

  5. Grade of satisfaction about new servicies

    Grade of satisfaction about new servicies (0-10)

    Measured: Through study completion, an average of 18 months

  6. Rating the degree of clinical impact to obtain the historical spirometry values of each patient.

    Rating the degree of clinical impact to obtain the historical spirometry values of each patient. Grade 0 -10

    Measured: Through study completion, an average of 18 months

  7. Number of avoided duplication tests using the EHR

    Number of avoided duplication tests using the EHR. measured as % of the total FS

    Measured: Through study completion, an average of 18 months

  8. Cost-effectiveness (Rating usability and speed of data transfer)

    Rating usability and speed of data transfer in minutes .

    Measured: Through study completion, an average of 18 months

  9. Cost-effectiveness (reducing the time of access to information and better display of the information)

    Questionnaire about reducing the time of access to information and better display of the information (measured in minutes).

    Measured: Through study completion, an average of 18 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Oct 2015 (estimated)
  2. Study start1 Mar 2019
  3. Primary completion20 Dec 2019 (estimated)
  4. Study completion20 Dec 2019 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case only
Time perspective
Prospective
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02592928
Sponsor's protocol ID
2015-PDMAR
Acronym
e-Spiro-HC3
Status last verified
Mar 2019
First submitted
15 Oct 2015
Last updated
4 Mar 2019
Results posted
No
Data monitoring committee
No

Publications

  • Cano I, Alonso A, Hernandez C, Burgos F, Barberan-Garcia A, Roldan J, Roca J. An adaptive case management system to support integrated care services: Lessons learned from the NEXES project. J Biomed Inform. 2015 Jun;55:11-22. doi: 10.1016/j.jbi.2015.02.011. Epub 2015 Mar 18.

    PubMed 25796455
  • Burgos F, Melia U, Vallverdu M, Velickovski F, Lluch-Ariet M, Caminal P, Roca J. Clinical decision support system to enhance quality control of spirometry using information and communication technologies. JMIR Med Inform. 2014 Oct 21;2(2):e29. doi: 10.2196/medinform.3179.

    PubMed 25600957
  • Melia U, Burgos F, Vallverdu M, Velickovski F, Lluch-Ariet M, Roca J, Caminal P. Algorithm for automatic forced spirometry quality assessment: technological developments. PLoS One. 2014 Dec 31;9(12):e116238. doi: 10.1371/journal.pone.0116238. eCollection 2014.

    PubMed 25551213
  • Velickovski F, Ceccaroni L, Roca J, Burgos F, Galdiz JB, Marina N, Lluch-Ariet M. Clinical Decision Support Systems (CDSS) for preventive management of COPD patients. J Transl Med. 2014 Nov 28;12 Suppl 2(Suppl 2):S9. doi: 10.1186/1479-5876-12-S2-S9. Epub 2014 Nov 28.

    PubMed 25471545
  • Llauger MA, Rosas A, Burgos F, Torrente E, Tresserras R, Escarrabill J; en nombre del grupo de trabajo de espirometria del Plan Director de las Enfermedades del Aparato Respiratorio (PDMAR). [Accesibility and use of spirometry in primary care centers in Catalonia]. Aten Primaria. 2014 Jun-Jul;46(6):298-306. doi: 10.1016/j.aprim.2013.12.012. Epub 2014 Apr 24. Spanish.

    PubMed 24768654
  • Burgos F, Disdier C, de Santamaria EL, Galdiz B, Roger N, Rivera ML, Hervas R, Duran-Tauleria E, Garcia-Aymerich J, Roca J; e-Spir@p Group. Telemedicine enhances quality of forced spirometry in primary care. Eur Respir J. 2012 Jun;39(6):1313-8. doi: 10.1183/09031936.00168010. Epub 2011 Nov 10.

    PubMed 22075488
  • Salas T, Rubies C, Gallego C, Munoz P, Burgos F, Escarrabill J. Technical requirements of spirometers in the strategy for guaranteeing the access to quality spirometry. Arch Bronconeumol. 2011 Sep;47(9):466-9. doi: 10.1016/j.arbres.2011.06.005. Epub 2011 Aug 6. English, Spanish.

    PubMed 21821333
  • Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J; ATS/ERS Task Force. Standardisation of spirometry. Eur Respir J. 2005 Aug;26(2):319-38. doi: 10.1183/09031936.05.00034805. No abstract available.

    PubMed 16055882
  • Vargas C, Burgos F, Cano I, Blanco I, Caminal P, Escarrabill J, Gallego C, Llauger MA, Miralles F, Solans O, Vallverdu M, Velickovski F, Roca J. Protocol for regional implementation of collaborative lung function testing. NPJ Prim Care Respir Med. 2016 Jun 2;26:16024. doi: 10.1038/npjpcrm.2016.24. No abstract available.

    PubMed 27251304

Questions about this trial

What is this clinical trial studying?

An observational study of Integrated Care and Telehealth, run by Hospital Clinic of Barcelona at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 4 Mar 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Primary Care Centers (PCC) and professionals involved in the territory using the Electronic Health Records (EHR) (time frame: Thought study completition in average of 18 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02592928, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2019.

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