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Research staff were blinded for all follow-up measurements. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures ie, 5-point knowledge, self-efficacy, readiness scales and action measures eg, surrogate designation, using a scale. No participant characteristic differed significantly among study arms at baseline. Advance care planning ACP is a process whereby people communicate their goals and preferences for future medical care.
To help overcome some of these barriers, we first created an easy-to-read AD that significantly increased 6-month documentation. This is a single-blind, parallel-group, randomized comparative effectiveness trial. The conceptual framework and the full trial protocol, 18 , 19 including inclusion and exclusion criteria; the study flow diagram; recruitment procedures; sample size estimates; and validity, reliability, and response options of all outcome measures have been previously published.
Using a modified informed consent process for vulnerable populations, 20 written informed consent was obtained for all participants. VA research audits were performed yearly. A full table of inclusion and exclusion criteria has been published. To be enrolled, veterans had to have an upcoming primary care appointment within 1 to 3 weeks.
As previously described, 19 after clinicians gave permission for study staff to contact their patients, we sent recruitment letters and made phone calls to describe the study and assess eligibility and interest. Names were randomly listed to ensure random recruitment, with oversampling of women and nonwhite veterans. Staff screened participants prior to enrollment. Given the potential benefits of ACP, we decided with our VA stakeholders to perform a comparative effectiveness study and provide all veterans some form of ACP.
No clinician-, electronic health record—, or systems-level changes were implemented as part of this trial. In the AD-only arm, veterans were asked to review the easy-to-read AD for 5 to 20 minutes within research offices. Research staff intervened only if there were technological issues and the study could not move forward.
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Our primary outcome was any new ACP documentation in the electronic medical record EMR 9 months after study enrollment. All medical review data were double-coded by 2 independent research assistants. Discrepancies were adjudicated by the principal investigator R. Secondary outcomes, measured at 1 week, 3 months, and 6 months, included the validated, patient-reported ACP Engagement Survey.
However, the nonassigned intervention was not described. The staff member who administered the intervention and baseline interview was not blinded. However, all follow-up outcome ascertainment was conducted by different staff blinded to group allocation. Research staff asked participants at each follow-up to not disclose the materials they reviewed, and staff documented whether they became unblinded.
If unblinding occurred, a third blinded staff member conducted all subsequent interviews. To ensure fidelity, staff followed study scripts and used checklists for every study phase.
Dustyn Williams, MD
Variables were assessed for distributional and outlier values using standard summary statistics. We used intention-to-treat analysis using SAS statistical software version 9. All P values were 2-tailed and set at a significance level of.
- Pale as Real Ladies: Poems for Pauline Johnson;
- Attention (Short Story Book 13);
- La scienza della relazione (Italian Edition)?
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We also adjusted all models for prior ACP documentation and potential clustering by physician. Ease-of-use, satisfaction, depression, and anxiety measures were assessed using the Wilcoxon rank test. There were no missing data for the primary outcome ie, all medical records were reviewed. If bias were to occur using this conservative approach, it would tend toward the null. The mean age of enrolled participants was The mean ACP documentation rate 6 months prior to intervention exposure was 0. There were no differences in participant characteristics between arms Table , and the number of enrolled veterans per clinician was 5 6 [range, ].
No adverse events were reported. The exam was created by experienced internal medicine leaders under the guidance of Dr. Georges Bordage, an expert in the key features approach. Key feature problems consist of a case scenario followed by questions which ask students to either prioritize a differential diagnosis, select which historical, physical exam, or testing data is necessary to diagnose the problem or identify the most appropriate management of the problem.
The exam is accompanied by student assessment reports with individual, class, and benchmark data. It can be used to replace or enhance an existing comprehensive assessment or to remediate students.
Aquifer Internal Medicine - formerly SIMPLE | A Case-based Virtual Course - Aquifer
After completing each case, students will have the option of calibrating their ability to apply their new knowledge and skills by completing five single-best answer vignette style self-assessment questions. Key feature problems consist of a case scenario followed by questions which ask students to either prioritize a differential diagnosis, select which historical, physical exam, or testing data is necessary to diagnose the problem or identify the most appropriate management of the problem.
The exam is accompanied by student assessment reports with individual, class, and benchmark data. It can be used to replace or enhance an existing comprehensive assessment or to remediate students. After completing each case, students will have the option of calibrating their ability to apply their new knowledge and skills by completing five single-best answer vignette style self-assessment questions. Each question includes clear explanations of the correct and incorrect responses for immediate feedback to students.
Alliance for Academic Internal Medicine.