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CDA 10-209 – HSR&D Study

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CDA 10-209
Effectively Involving Diabetes Caregivers in the VA Medical Home
Ann-Marie Rosland MD MS
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: September 2011 - August 2016

BACKGROUND/RATIONALE:
The overall goal of this research is to lay the groundwork for development of clinical interventions that leverage caregivers' significant presence, interest, and influence on veterans' diabetes management, in order to improve veterans' diabetes outcomes.

OBJECTIVE(S):
We aim to 1)identify the illness-care support roles that informal caregivers currently have in VHA primary care of diabetes, 2)assess the potential, and most promising means, for providers to engage caregivers of diabetes patients, 3)examine the most effective and feasible ways to support diabetes caregiver effectiveness within the VA PACT (Patient Centered Medical Home) context of care, and 4) develop clinical programs for use in the VA PACT that will support engagement and effectiveness of caregivers of diabetes patients.

METHODS:
Initial qualitative research (Aim 1.1) will involve interviews with veterans with approximately 20 veterans with high-risk diabetes, their caregivers, and approximately 20 primary care clinical staff members about caregiver roles in medical care of diabetes and in navigating the health system, and needs for support of these caregiver roles. The results will inform development of instruments that assess specific caregiver roles and needs in diabetes care (Aim 1.2). Then we will conduct a needs assessment via a survey among 1000 Ann Arbor VA patients with high-risk diabetes (Aim 2), to assess the needs for and most potentially effective content for a local diabetes caregiving intervention. We will link survey responses to patient clinical and administrative data to further evaluate caregiving support needs by patient sub-group (such as those with multiple comorbidities). Finally, the results of Aims 1 and 2 will guide the development of a pilot intervention (Aim 3) that will be tested locally in preparation for an intervention trial.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This project will provide information on specific and clinically-relevant ways that caregivers help patients manage chronic illnesses, and that clinicians can use to better engage and support these caregivers. The CO-IMPACT intervention will help Veterans and the VA identify ways that caregivers can more effectively support patient diabetes management and health system navigation. If successful, this intervention could be implemented in VA PACT clinical practice and could be adapted to patients with other chronic health management needs.

PUBLICATIONS:

Journal Articles

  1. Wong ES, Rosland AM, Fihn SD, Nelson KM. Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden. Journal of general internal medicine. 2016 Dec 1; 31(12):1467-1474.
  2. Trivedi R, Slightam C, Fan VS, Rosland AM, Nelson K, Timko C, Asch SM, Zeliadt SB, Heidenreich P, Hebert PL, Piette JD. A Couples' Based Self-Management Program for Heart Failure: Results of a Feasibility Study. Frontiers in public health. 2016 Aug 29; 4:171.
  3. Rosland AM, Kieffer E, Spencer M, Sinco B, Palmisano G, Valerio M, Nicklett E, Heisler M. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? Patient education and counseling. 2015 Nov 1; 98(11):1402-9.
  4. Chen LM, Sakshaug JW, Miller DC, Rosland AM, Hollingsworth J. The association among medical home readiness, quality, and care of vulnerable patients. The American journal of managed care. 2015 Aug 1; 21(8):e480-6.
  5. Rosland AM, Krein SL, Kim HM, Greenstone CL, Tremblay A, Ratz D, Saffar D, Kerr EA. Measuring patient-centered medical home access and continuity in clinics with part-time clinicians. The American journal of managed care. 2015 May 1; 21(5):e320-8.
  6. Aikens JE, Rosland AM, Piette JD. Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Primary Care Diabetes. 2015 Apr 1; 9(2):127-34.
  7. Damschroder LJ, Robinson CH, Francis J, Bentley DR, Krein SL, Rosland AM, Hofer TP, Kerr EA. Effects of performance measure implementation on clinical manager and provider motivation. Journal of general internal medicine. 2014 Dec 1; 29 Suppl 4:877-84.
  8. Helfrich CD, Dolan ED, Fihn SD, Rodriguez HP, Meredith LS, Rosland AM, Lempa M, Wakefield BJ, Joos S, Lawler LH, Harvey HB, Stark R, Schectman G, Nelson KM. Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics. Healthcare (Amsterdam, Netherlands). 2014 Dec 1; 2(4):238-44.
  9. LeBron AM, Valerio MA, Kieffer E, Sinco B, Rosland AM, Hawkins J, Espitia N, Palmisano G, Spencer M. Everyday discrimination, diabetes-related distress, and depressive symptoms among African Americans and Latinos with diabetes. Journal of immigrant and minority health / Center for Minority Public Health. 2014 Dec 1; 16(6):1208-16.
  10. Rosland AM, Piette JD, Lyles CR, Parker MM, Moffet HH, Adler NE, Schillinger D, Karter AJ. Social support and lifestyle vs. medical diabetes self-management in the diabetes study of Northern California (DISTANCE). Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2014 Dec 1; 48(3):438-47.
  11. Trivedi R, Beaver K, Bouldin ED, Eugenio E, Zeliadt SB, Nelson K, Rosland AM, Szarka JG, Piette JD. Characteristics and well-being of informal caregivers: Results from a nationally-representative US survey. Chronic Illness. 2014 Sep 1; 10(3):167-79.
  12. Piette JD, Aikens JE, Rosland AM, Sussman JB. Rethinking the frequency of between-visit monitoring for patients with diabetes. Medical care. 2014 Jun 1; 52(6):511-8.
  13. Nicklett EJ, Heisler ME, Spencer MS, Rosland AM. Direct social support and long-term health among middle-aged and older adults with type 2 diabetes mellitus. The journals of gerontology. Series B, Psychological sciences and social sciences. 2013 Nov 1; 68(6):933-43.
  14. Hawkins J, Kieffer EC, Sinco B, Spencer M, Anderson M, Rosland AM. Does gender influence participation? Predictors of participation in a community health worker diabetes management intervention with African American and Latino adults. The Diabetes educator. 2013 Sep 1; 39(5):647-54.
  15. Zulman DM, Piette JD, Jenchura EC, Asch SM, Rosland AM. Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers. Journal of medical Internet research. 2013 Jul 10; 15(7):e123.
  16. Rosland AM, Nelson K, Sun H, Dolan ED, Maynard C, Bryson C, Stark R, Shear JM, Kerr E, Fihn SD, Schectman G. The patient-centered medical home in the Veterans Health Administration. The American journal of managed care. 2013 Jul 1; 19(7):e263-72.
  17. Rosland AM, Heisler M, Janevic MR, Connell CM, Langa KM, Kerr EA, Piette JD. Current and potential support for chronic disease management in the United States: the perspective of family and friends of chronically ill adults. Families, systems & health : the journal of collaborative family healthcare. 2013 Jun 1; 31(2):119-31.
  18. Heisler M, Choi H, Piette JD, Rosland A, Langa KM, Brown S. Adults with cardiovascular disease who help others: a prospective study of health outcomes. Journal of behavioral medicine. 2013 Apr 1; 36(2):199-211.
  19. Piette JD, Rosland AM, Marinec NS, Striplin D, Bernstein SJ, Silveira MJ. Engagement with automated patient monitoring and self-management support calls: experience with a thousand chronically ill patients. Medical care. 2013 Mar 1; 51(3):216-23.
  20. Janevic MR, Rosland AM, Wiitala W, Connell CM, Piette JD. Providing support to relatives and friends managing both chronic physical illness and depression: the views of a national sample of U.S. adults. Patient education and counseling. 2012 Oct 1; 89(1):191-8.
  21. Rosland AM, Heisler M, Piette JD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. Journal of behavioral medicine. 2012 Apr 1; 35(2):221-39.
  22. Zulman DM, Rosland AM, Choi H, Langa KM, Heisler M. The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status. Patient education and counseling. 2012 Apr 1; 87(1):74-80.
  23. Spencer MS, Rosland AM, Kieffer EC, Sinco BR, Valerio M, Palmisano G, Anderson M, Guzman JR, Heisler M. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. American journal of public health. 2011 Dec 1; 101(12):2253-60.
  24. Wharam JF, Frank MB, Rosland AM, Paasche-Orlow MK, Farber NJ, Sinsky C, Rucker L, Rask KJ, Barry MJ, Figaro MK. "Pay-for-performance" as a quality improvement tool: perceptions and policy recommendations of physicians and program leaders. Quality management in health care. 2011 Jul 1; 20(3):234-45.
  25. Piette JD, Rosland AM, Silveira MJ, Hayward R, McHorney CA. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse? Patient preference and adherence. 2011 Apr 20; 5:187-94.
  26. Rosland AM, Piette JD, Choi H, Heisler M. Family and friend participation in primary care visits of patients with diabetes or heart failure: patient and physician determinants and experiences. Medical care. 2011 Jan 1; 49(1):37-45.
Journal Other

  1. Quinn M, Robinson C, Forman J, Krein SL, Rosland AM. Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings: Available and Needed Measures. Medical care. 2017 Jul 1; 55 Suppl 7 Suppl 1:S84-S91.
  2. Rosland AM. A piece of my mind. Assuming the worst. JAMA : the journal of the American Medical Association. 2015 Jun 9; 313(22):2229-30.
  3. Piette JD, Rosland AM, Marinec NS, Striplin D, Bernstein SJ, Silveira MJ. Response to letter with regard to our paper "Engagement with automated patient monitoring and self-management support calls": experience with a thousand chronically ill patients. Medical care. 2013 Nov 1; 51(11):1027-8.
Conference Presentations

  1. Rosland A, Wong E, Zulman DM, Piegari R, Prenovost K, Fihn S, Nelson K. Higher Level of Patient-Centered Medical Home Implementation Associated with Improvements in Clinical Quality of Care in the Nation-Wide VHA PACT Initiative. Paper presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.
  2. Piette JD, Aikens J, Rosland A, Sussman JB. Re-thinking the frequency of between-visit mHealth monitoring for patients with diabetes. Paper presented at: American Telemedicine Association Annual Meeting; 2014 May 19; Baltimore, MD.
  3. Forman JH, Harrod M, Robinson CH, Rosland A, Saffar D, Greenstone CL, Tremblay AS, Kerr EA. Patient experiences of and preferences for access and continuity of care in a patient-centered medical home. Paper presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  4. Piette JD, Aikens J, Rosland A, Sussman JB. Re-thinking the frequency of between-visit mHealth monitoring for patients with diabetes. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2014 Apr 23; Philadelphia, PA.
  5. Robinson CH, Harrod M, Forman JH, Tremblay AS, Kerr EA, Rosland A. Challenges to Increasing Access and Continuity in a Large Academic Medical Center Implementing PCMH. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 23; San Diego, CA.
  6. Rosland A. Engaging Family Members in the Medical Care of Patients with Diabetes. Paper presented at: Michigan Center for Diabetes Translational Research Symposium; 2014 Apr 11; Ann Arbor, MI.
  7. Rosland A. Part-Time Primary Care Physician Access and Continuity: Implications for the Patient Centered Medical Home. Poster session presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  8. Rosland A. Part-time primary care physician access and continuity in the patient centered medical home. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 26; Denver, CO.
  9. Rosland A, Ayanian J. Taking the first steps in your research career: obtaining a career development award. Paper presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 25; Denver, CO.
  10. Trivedi RB, Beaver K, Zeliadt SB, Nelson KM, Eugenio E, Rosland AM, Grimesey J, Bouldin E, Piette JD. Who are informal caregivers? Results from a nationally-representative study. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2013 Mar 20; San Francisco, CA.
  11. Spencer MS, Espitia NR, Sinco BR, Nicklett E, Rosland A, Kieffer E, Palmisano G, Heisler MM. Using Structural Equation Modeling to Understand the Process of Change in a Community Health Worker Intervention for African American and Latinos with Type 2 Diabetes. Paper presented at: Society for Social Work and Research Annual Conference; 2013 Jan 16; San Diego, CA.
  12. Eisen S, Fihn SD, Krein S, Nelson KM, Rosland AM, Yano E. National Implementation of Patient-Centered Medical Home: Early Lessons from the VA PACT Initiative. Presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL.
  13. Rosland A, Stark R, Shear J, Fihn S, Schectman G. Implementing Patient Centered Medical Homes in the Veterans Health Administration. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL.
  14. Zulman DM, Piette JD, Asch SM, Rosland A. Enhancing Out-of-Home Informal Caregiving through Health Information Technology. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 9; Orlando, FL.
  15. Piette JD, Trivedi R, Silveira MJ, Rosland AM. Emerging Research on Caregiving Workshop. Paper presented at: VA HSR&D National Meeting; 2011 Feb 18; Washington, DC.


DRA: Aging, Older Veterans' Health and Care, Diabetes and Related Disorders
DRE: Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: none
MeSH Terms: none

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