EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial.
Date
2024-08
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Abstract
Background
Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the potential to improve outcomes in treatment-resistant chronic disease by supporting self-management and facilitating patient-clinician contact but must be designed in a manner amenable to real-world use.Methods
Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) is an ongoing randomized trial comparing two 12-month interventions for comorbid PPDM and hypertension: 1) EXTEND, a mobile monitoring-enabled self-management intervention; and 2) EXTEND Plus, a comprehensive, nurse-delivered telehealth program incorporating mobile monitoring, self-management support, and pharmacist-supported medication management. Both arms leverage a novel platform that uses existing technological infrastructure to enable transmission of patient-generated health data into the electronic health record. The primary study outcome is difference in HbA1c change from baseline to 12 months. Secondary outcomes include blood pressure, weight, implementation barriers/facilitators, and costs.Results
Enrollment concluded in June 2023 following randomization of 220 patients. Baseline characteristics are similar between arms; mean age is 54.5 years, and the cohort is predominantly female (63.6 %) and Black (68.2 %), with a baseline HbA1c of 9.81 %.Conclusion
The EXTEND trial is evaluating two mobile monitoring-enabled telehealth approaches that seek to improve outcomes for patients with PPDM and hypertension. Critically, these approaches are designed around existing infrastructure, so may be amenable to implementation and scaling. This study will promote real-world use of telehealth to maximize benefits for those with high-risk chronic disease.Type
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
German, Jashalynn, Qing Yang, Daniel Hatch, Allison Lewinski, Hayden B Bosworth, Brystana G Kaufman, Ranee Chatterjee, Gina Pennington, et al. (2024). EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND): Protocol and Baseline Data for a Randomized Trial. Contemporary clinical trials. p. 107673. 10.1016/j.cct.2024.107673 Retrieved from https://hdl.handle.net/10161/31460.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Allison A. Lewinski
As a nurse scientist and health services researcher, with a joint appointment between the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA), I have acquired expertise in the areas of diabetes distress, qualitative research methods, and virtual care (e.g., telehealth, digital health) as a method of care delivery. My research focuses on the current and potential ability of virtual care interventions to reduce distress, improve self-management, increase access to evidence-based care delivery, and improve patient and population health outcomes. My collaborative and interdisciplinary research focuses on how patient-, provider-, and system-level factors influence virtual care use and outcomes. As evidence of its growing significance and impact at DUSON and the VHA, my work has been well funded, published in high-impact journals, presented at select conferences, and used to guide health system decision-making. I am a sought-after teacher and mentor because I connect my research interests to teaching students and mentees rigorous and systematic research approaches. I am frequently asked by local and national colleagues to provide guidance on distress, qualitative research methods, and virtual care approaches used in grants, projects, and manuscripts.
My research contributions have focused on alleviating psychosocial distress, developing and implementing multi-level virtual care interventions, and enhancing qualitative methods. As a staff nurse, I witnessed the psychosocial distress of patients who experience challenges in obtaining care which led to my interest in diabetes distress. I aspire and work to improve health outcomes for individuals with chronic illness by developing equitable and sustainable multi-level virtual care interventions and assessing their implementation and adaptation. Virtual care describes any remote interaction between a patient and/or members of their care team. To achieve these goals, I use qualitative methods and implementation science approaches to enhance alignment between patient, modality, disease state, and social and environmental context; my collective assessments address for whom and what purposes, in what situations and contexts, when in a disease course or clinical activity, and in what specific ways such interventions are effective. My focus on the uptake and adoption of virtual care to address psychosocial distress considers interactions with patients, between patients and clinicians, and within health care systems and the larger population.
Brystana G. Kaufman
Areas of Expertise: Health Economics, Health Policy, and Health Services Research
Dr. Kaufman is a health services researcher focused on improving the value of care for older adults with complex care needs, such as serious illness or developmental disability. She brings expertise in causal inference as well as Medicaid and Medicare value-based payment models to inform evidence-based program design. Her work prioritizes the evaluation of health disparities for underserved communities and seeks to inform whole-person models of care that integrate traditional clinical services with behavioral health, socioeconomic and social supports to address older adults’ diverse needs and reflect their preferences for care. She worked with the CMS Innovation Center as a 2022-2023 Health and Aging Policy fellow, and she is core faculty with the Duke-Margolis Institute for Health Policy.
Dr. Kaufman received her Master of Science in Public Health and PhD in Health Policy and Management from the Gillings School of Global Public Health at the University of North Carolina-Chapel Hill.
Ranee Chatterjee
Ryan Shaw
As the Chief Nurse Innovation Officer at Duke University Health System, I advance nursing practice through innovative solutions across disciplines and methodologies. By leveraging technology and evidence-based practices, I help identify new opportunities to address challenges in healthcare delivery, improve patient outcomes, and drive efficiency.
Nurses need more opportunity to innovate so that they can better care for patients and their families. I see my role as empowering nurses to thrive as changemakers.
In addition, I teach classes in health informatics and research methods, and mentor students and trainees to become the next generation of health scientists and clinicians.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.