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CDA 13-261 – HSR&D Study

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CDA 13-261
Tailored, eHealth-based Management for Persistent Poorly-Controlled Diabetes
Matthew Crowley MD
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: August 2014 - July 2019

BACKGROUND/RATIONALE:
This career development award (CDA) will improve the management of Veterans with persistent poorly-controlled diabetes mellitus (PPDM), defined by maintenance of a hemoglobin A1c (HbA1c) continuously >8.5% for >1 year despite standard approaches to diabetes care. Diabetes is: 1) the leading cause of kidney failure, limb amputation, and blindness among Veterans; 2) a risk factor for heart attack, stroke, and mortality; and 3) among the most costly diseases to Veterans Affairs (VA). Because complications rise exponentially as HbA1c increases, Veterans with PPDM are the highest-risk diabetes patients within VA.

OBJECTIVE(S):
Given its disproportionate contribution to diabetes complications and costs, novel approaches to managing PPDM are needed. Two evidence gaps have hindered the development of such novel interventions for Veterans with PPDM: 1) the optimal diabetes management content to address factors underlying PPDM in Veterans is unclear; and 2) the ideal intervention delivery strategy for Veterans with PPDM is not known. This CDA will address these gaps and generate a novel intervention specifically designed to improve diabetes control among Veterans with PPDM. This CDA hypothesizes that an intervention for PPDM will be effective if it: 1) delivers content targeting specific barriers to improved control in PPDM; and 2) utilizes a delivery strategy that can facilitate frequent patient-provider contact in a manner consistent with Veteran preferences.

METHODS:
This CDA comprises three complementary Specific Aims, guided by a theoretical framework based on the Health Belief Model. Aim 1 analyzes existing data to identify patient factors and utilization patterns associated with PPDM, which will inform the selection of intervention content. Aim 2 utilizes qualitative methodology to query stakeholders regarding perceived barriers and facilitators of diabetes control in PPDM, which will refine intervention content and identify the intervention delivery strategies preferred by Veterans with PPDM. Data from Aims 1 and 2 will yield a novel intervention for Veterans with PPDM, which will be studied for Aim 3.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This CDA will create an effective, patient-centered treatment option for Veterans with PPDM, the most poorly-controlled, highest-risk diabetes patients in VA. These projects have relevance to multiple VA HSR&D strategic priorities. Ultimately, by using a high-impact intervention to address a costly condition in a refractory Veteran population, this CDA has the potential to transform how VA cares for poorly-controlled chronic illness.

PUBLICATIONS:

Journal Articles

  1. Alexopoulos AS, Jackson GL, Edelman D, Smith VA, Berkowitz TSZ, Woolson SL, Bosworth HB, Crowley MJ. Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study. PLoS ONE. 2019 Mar 29; 14(3):e0214679.
  2. Yang JY, Wang T, Pate V, Gower EW, Crowley MJ, Buse JB, Stürmer T. Sodium-glucose co-transporter-2 inhibitor use and risk of lower-extremity amputation: Evolving questions, evolving answers. Diabetes, Obesity & Metabolism. 2019 May 1; 21(5):1223-1236.
  3. Alexopoulos AS, Qamar A, Hutchins K, Crowley MJ, Batch BC, Guyton JR. Triglycerides: Emerging Targets in Diabetes Care? Review of Moderate Hypertriglyceridemia in Diabetes. Current Diabetes Reports. 2019 Feb 26; 19(4):13.
  4. Crowley MJ, Gokhale M, Pate V, Stürmer T, Buse JB. Impact of metformin use on the cardiovascular effects of dipeptidyl peptidase-4 inhibitors: An analysis of Medicare claims data from 2007 to 2015. Diabetes, Obesity & Metabolism. 2018 Nov 20.
  5. Diamantidis CJ, Bosworth HB, Oakes MM, Davenport CA, Pendergast JF, Patel S, Moaddeb J, Barnhart HX, Merrill PD, Baloch K, Crowley MJ, Patel UD. Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study: Protocol and baseline characteristics of a randomized controlled trial. Contemporary clinical trials. 2018 Jun 1; 69:28-39.
  6. Bosworth HB, Olsen MK, McCant F, Stechuchak KM, Danus S, Crowley MJ, Goldstein KM, Zullig LL, Oddone EZ. Telemedicine cardiovascular risk reduction in veterans: The CITIES trial. American heart journal. 2018 May 1; 199:122-129.
  7. Barton AB, Okorodudu DE, Bosworth HB, Crowley MJ. Clinical Inertia in a Randomized Trial of Telemedicine-Based Chronic Disease Management: Lessons Learned. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2018 Oct 1; 24(10):742-748.
  8. Eisenberg A, Crowley MJ, Coffman C, Edelman D. Effect of a group medical clinic for veterans with diabetes on body mass index. Chronic Illness. 2018 Jan 1; 1742395317753885.
  9. Telford O, Diamantidis CJ, Bosworth HB, Patel UD, Davenport CA, Oakes MM, Crowley MJ. The relationship between Pittsburgh Sleep Quality Index subscales and diabetes control. Chronic Illness. 2018 Jan 1; 1742395318759587.
  10. Crowley MJ, Williams JW, Kosinski AS, D DA, Buse JB. Metformin Use May Moderate the Effect of DPP-4 Inhibitors on Cardiovascular Outcomes. Diabetes Care. 2017 Dec 1; 40(12):1787-1789.
  11. Vemulapalli S, Parikh K, Coeytaux R, Hasselblad V, McBroom A, Johnston A, Raitz G, Crowley MJ, Lallinger KR, Jones WS, Sanders GD. Systematic review and meta-analysis of endovascular and surgical revascularization for patients with chronic lower extremity venous insufficiency and varicose veins. American heart journal. 2018 Feb 1; 196:131-143.
  12. Khazanie P, Al-Khatib SM, Wang TY, Crowley MJ, Kressin NR, Krumholz HM, Kiefe CI, Wells BL, O'Brien SM, Peterson ED, Sanders GD. Training cardiovascular outcomes researchers: A survey of mentees and mentors to identify critical training gaps and needs. American heart journal. 2018 Feb 1; 196:170-177.
  13. Crowley MJ, Al-Khatib SM, Wang TY, Khazanie P, Kressin NR, Krumholz HM, Kiefe CI, Wells BL, O'Brien SM, Peterson ED, Sanders GD. How well does early-career investigators' cardiovascular outcomes research training align with funded outcomes research?. American heart journal. 2018 Feb 1; 196:163-169.
  14. Crowley MJ, Edelman D, Voils CI, Maciejewski ML, Coffman CJ, Jeffreys AS, Turner MJ, Gaillard LA, Hinton TA, Strawbridge E, Zervakis J, Barton AB, Yancy WS. Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial. Contemporary clinical trials. 2017 Jul 1; 58:1-12.
  15. Andrews SM, Sperber NR, Gierisch JM, Danus S, Macy SL, Bosworth HB, Edelman D, Crowley MJ. Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes. Patient preference and adherence. 2017 Mar 3; 11:469-478.
  16. Crowley MJ, Diamantidis CJ, McDuffie JR, Cameron CB, Stanifer JW, Mock CK, Wang X, Tang S, Nagi A, Kosinski AS, Williams JW. Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease: A Systematic Review. Annals of internal medicine. 2017 Feb 7; 166(3):191-200.
  17. Campbell EA, Crowley MJ, Powers BJ, Sanders LL, Olsen MK, Danus S, McNeill DB, Zaas AK. Diabetes Quality of Care Before and After Implementation of a Resident Clinic Practice Partnership System. American journal of medical quality : the official journal of the American College of Medical Quality. 2017 Jan 1; 32(1):66-72.
  18. Gayer CC, Crowley MJ, Lawrence WF, Gierisch JM, Gaglio B, Williams JW, Myers ER, Kendrick A, Slutsky J, Sanders GD. An overview and discussion of the Patient-Centered Outcomes Research Institute's decision aid portfolio. Journal of comparative effectiveness research. 2016 Jul 1; 5(4):407-15.
  19. Crowley MJ, Olsen MK, Woolson SL, King HA, Oddone EZ, Bosworth HB. Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management. Journal of clinical hypertension (Greenwich, Conn.). 2016 Apr 1; 18(4):322-8.
  20. Al-Khatib SM, Gierisch JM, Crowley MJ, Coeytaux RR, Myers ER, Kendrick A, Sanders GD. Future Research Prioritization: Implantable Cardioverter-Defibrillator Therapy in Older Patients. Journal of general internal medicine. 2015 Dec 1; 30(12):1812-20.
  21. Crowley MJ, Edelman D, McAndrew AT, Kistler S, Danus S, Webb JA, Zanga J, Sanders LL, Coffman CJ, Jackson GL, Bosworth HB. Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2016 May 1; 22(5):376-84.
  22. Myers ER, Moorman P, Gierisch JM, Havrilesky LJ, Grimm LJ, Ghate S, Davidson B, Mongtomery RC, Crowley MJ, McCrory DC, Kendrick A, Sanders GD. Benefits and Harms of Breast Cancer Screening: A Systematic Review. JAMA. 2015 Oct 20; 314(15):1615-34.
  23. Shaw RJ, Zullig LL, Crowley MJ, Grambow SC, Lindquist JH, Shah BR, Peterson E, Bosworth HB. Willingness of Patients to Use Computers for Health Communication and Monitoring Following Myocardial Infarction. Computers, Informatics, Nursing : CIN. 2015 Sep 1; 33(9):384-9.
  24. Zullig LL, Stechuchak KM, Goldstein KM, Olsen MK, McCant FM, Danus S, Crowley MJ, Oddone EZ, Bosworth HB. Patient-reported medication adherence barriers among patients with cardiovascular risk factors. Journal of managed care & specialty pharmacy. 2015 Jun 1; 21(6):479-85.
  25. Zullig LL, Shaw RJ, Shah BR, Peterson ED, Lindquist JH, Crowley MJ, Grambow SC, Bosworth HB. Patient-provider communication, self-reported medication adherence, and race in a postmyocardial infarction population. Patient preference and adherence. 2015 Feb 19; 9:311-8.
  26. Zullig LL, Gellad WF, Moaddeb J, Crowley MJ, Shrank W, Granger BB, Granger CB, Trygstad T, Liu LZ, Bosworth HB. Improving diabetes medication adherence: successful, scalable interventions. Patient preference and adherence. 2015 Jan 23; 9:139-49.
  27. Crowley MJ, Zullig LL, Shah BR, Shaw RJ, Lindquist JH, Peterson ED, Bosworth HB. Medication non-adherence after myocardial infarction: an exploration of modifying factors. Journal of general internal medicine. 2015 Jan 1; 30(1):83-90.
  28. Beadles CA, Voils CI, Crowley MJ, Farley JF, Maciejewski ML. Continuity of medication management and continuity of care: Conceptual and operational considerations. SAGE open medicine. 2014 Dec 9; 2:2050312114559261.
  29. Crowley MJ, Holleman R, Klamerus ML, Bosworth HB, Edelman D, Heisler M. Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illness. 2014 Dec 1; 10(4):291-302.
  30. Gierisch JM, Myers ER, Schmit KM, McCrory DC, Coeytaux RR, Crowley MJ, Chatterjee R, Kendrick AS, Sanders GD. Prioritization of patient-centered comparative effectiveness research for osteoarthritis. Annals of internal medicine. 2014 Jun 17; 160(12):836-41.
  31. Crowley MJ, McCrory DC, Chatterjee R, Gierisch JM, Myers ER, Schmit KM, Coeytaux RR, Correll CU, Kendrick AS, Sanders GD. Prioritization of research addressing antipsychotics for adolescents and young adults with bipolar disorder. Annals of internal medicine. 2014 Apr 1; 160(7):492-8.
  32. Crowley MJ, Melnyk SD, Ostroff JL, Fredrickson SK, Jeffreys AS, Coffman CJ, Edelman D. Can group medical clinics improve lipid management in diabetes? The American journal of medicine. 2014 Feb 1; 127(2):145-51.
  33. Zullig LL, Shaw RJ, Crowley MJ, Lindquist J, Grambow SC, Peterson E, Shah BR, Bosworth HB. Association between perceived life chaos and medication adherence in a postmyocardial infarction population. Circulation. Cardiovascular quality and outcomes. 2013 Nov 12; 6(6):619-25.
  34. Okorodudu DE, Okorodudu DE, Crowley MJ, Sebastian S, Rowell JV, Guyton JR, Rowell JV, Guyton JR. Inherited lipemic splenomegaly and the spectrum of apolipoprotein E p.Leu167del mutation phenotypic variation. Journal of clinical lipidology. 2013 Nov 1; 7(6):566-72.
Journal Other

  1. Crowley MJ, Maciejewski ML. Revisiting NPH Insulin for Type 2 Diabetes: Is a Step Back the Path Forward? JAMA. 2018 Jul 3; 320(1):38-39.
  2. Crowley MJ. Capsule Commentary on Axon et al., Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus. Journal of general internal medicine. 2016 Nov 1; 31(11):1357.
  3. Bosworth HB, Crowley MJ. Self-monitoring and self-titration of antihypertensive medication reduces systolic blood pressure compared with usual care. [Editorial]. Evidence-based nursing. 2015 Jul 1; 18(3):87.
  4. Crowley M, Bosworth HB. Health Coaching by Medical Assistants - Promise and Uncertainty. [Editorial]. Annals of Family Medicine. 2015 Feb 26; 13(2):Reply to 130-138.
Reports

  1. Jones WS, Vemulapalli S, Parikh KS, Coeytaux RR, Crowley MJ, Raitz G, Johnston AL, Hasselblad V, McBroom AJ, Lallinger KR, Sanders-Schmidler GD. Treatment Strategies for Patients with Lower Extremity Chronic Venous Disease (LECVD). 2017 Apr 6.
  2. Crowley MJ, Diamantidis CJ, McDuffie JR, Cameron B, Stanifer J, Mock CK, Kosinski A, Wang X, Tang S, Williams JW. Metformin Use in Patients with Historical Contraindications or Precautions [Internet]. Washington (DC): Department of Veterans Affairs (US); 2016 Sep 1. 87 p.
Conference Presentations

  1. Crowley M, Edelman D, Berkowitz TS, Smith V, Woolson S, Jackson GL. Characterization of Veterans with Persistently Poor Diabetes Control: Data from a Nationwide Cohort. Poster session presented at: American Diabetes Association Annual Scientific Session; 2016 Jun 12; New Orleans, LA.
  2. Crowley M, Edelman D, Berkowitz TS, Smith V, Woolson S, Jackson GL. Medication Use among Veterans with Persistently Poor Diabetes Control: Data from a Nationwide Cohort. Paper presented at: American Diabetes Association Annual Scientific Session; 2016 Jun 12; New Orleans, LA.
  3. Crowley M, Edelman D, Smith V, Berkowitz TS, Woolson S, Jackson GL. Characterization of Veterans with persistently poor diabetes control: data from a large, nationwide cohort. Poster session presented at: VA Career Development Award Program Annual Conference; 2016 Feb 8; Arlington, VA.
  4. Crowley M, Edelman D, McAndrew AT, Kistler SN, Danus SM, Webb JA, Zanga J, Sanders L, Coffman CJ, Jackson GL, Bosworth HB. Effectiveness of a Scalable Telemedicine Intervention for Veterans with Persistent Poor Diabetes Control. Paper presented at: American Diabetes Association Annual Scientific Session; 2015 Jul 9; Boston, MA.
  5. Crowley M, Sperber N, Gierisch JM, Edelman D, McAndrew AT, Kistler S, Danus SM, Jackson GL, Bosworth HB. Patient Perceptions of Effective, Scalable Telemedicine Care for Veterans with Persistent Poor Diabetes Control. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
  6. Zullig LL, Stechuchak KM, Goldstein K, Olsen MK, McCant FA, Danus SM, Crowley M, Oddone EZ, Bosworth HB. Patient-Reported Medication Adherence Barriers among Veterans Affairs Patients with Cardiovascular Risk Factors. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 23; Toronto, Canada.
  7. Beadles CA, Voils CI, Crowley M, Maciejewski ML. Continuity of medication management and continuity of care: Conceptual and operational considerations. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
  8. Crowley M, Olsen MK, King HA, Powers BJ, Oddone EZ, Bosworth HB. The impact of baseline antihypertensive burden on response to medication and behavior management interventions for hypertension. Poster session presented at: VA Durham VAMC Annual Research Week; 2014 May 13; Durham, NC.
  9. Crowley M. Advanced Comprehensive Diabetes Care for Veterans with persistent poorly-controlled diabetes. Poster session presented at: Duke Institute for Health Innovation Summit on Transformative Innovation in Health Care; 2013 Sep 9; Durham, NC.


DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems, Diabetes and Related Disorders
DRE: Treatment - Observational, Prevention, Technology Development and Assessment, Treatment - Implementation
Keywords: Complementary and Alternative Practices
MeSH Terms: none