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HypertensionENCOMPASSNCT04790617

ENCOMPASS: Expansion Study B, RCT

A study testing Community Health Navigator Program in people with Hypertension and Diabetes Mellitus, Type 2, run by University of Calgary at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Some patients living with multiple long-term health conditions have difficulty accessing the services they need, despite available primary care and community resources. Patient navigation programs may help those with complex health conditions to improve their care and outcomes. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Community Health Navigator Program
Could I receive a placebo?
No, everyone receives an active treatment
How many people
183 participants
Where
1 siteCanada
Study dates
1 Mar 2021to 10 Nov 2023
Phase
Interventional
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Poorly controlled hypertension (most recent systolic blood pressure > 160 mmHg or labile);
  • Poorly controlled diabetes (A1C > 9% on at least one occasion within the past year or labile);
  • Stage 3b or greater chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73m2 in past year);
  • Established ischemic heart disease (at least one instance of a physician billing diagnosis with a relevant International Classification of Diseases, 9th Edition [ICD-9] code recorded in electronic medical record (EMR), or known to health care team);
  • Congestive heart failure (at least one instance of a physician billing diagnosis with a relevant ICD-9 code recorded in EMR, or known to health care team);
  • Chronic obstructive pulmonary disease OR Asthma with at least two visits in the past year (at least 2 instances of a physician billing diagnosis with a relevant ICD-9 code, or known to health care team).

Who cannot join

  • Patient unable to provide informed consent;
  • Patient residing in long-term care facility;
  • Health care provider discretion.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • Calgary West Central Primary Care Network

    Calgary, Alberta

Other trials in Canada

About this study

Official title: Enhancing Community Health Through Patient Navigation, Advocacy and Social Support (ENCOMPASS): Expansion Study B, A Randomized Controlled Trial

Some patients living with multiple long-term health conditions have difficulty accessing the services they need, despite available primary care and community resources. Patient navigation programs may help those with complex health conditions to improve their care and outcomes. Community health navigators (CHNs) are community members who help guide patients through the health care system. CHNs are not health professionals like a doctor or nurse, but they are specially trained to help patients get the most out of their health care and connect them to resources. The ENCOMPASS program of research evaluates a patient navigation program that connects patients living with long-term health conditions to CHNs. To understand if the CHN program can be scaled to a provincial level, the ENCOMPASS program of research is expanding to select primary care settings across Alberta. This study implements and evaluates the CHN program at Calgary West Central Primary Care Network in Calgary, Alberta, Canada.

Read the detailed description

Community Health Navigators (CHNs) are defined as community health workers that provide patient navigation. Based on evidence to date, CHNs for chronic disease management are likely to beneficially impact patient experience, clinical outcomes and costs; however, contextual evidence is lacking given that most studies to date have been conducted in the United States. In Canada, patient navigation programs currently exist in only a few settings (primarily cancer treatment and transitional care), with few navigation programs implemented in chronic disease care.

The ENCOMPASS program of research was initiated in 2016, when researchers with the University of Calgary's Interdisciplinary Chronic Disease Collaboration partnered with Mosaic Primary Care Network (PCN) to develop, implement and evaluate a community health navigation program for patients with multiple chronic conditions. The program was based on a systematic literature review and refined in consultation with key stakeholders. A cluster-randomized controlled trial is currently ongoing with Mosaic PCN to determine the impact of the program on acute care use, patient-reported outcomes and experience, and disease-specific clinical outcomes (NCT03077386).

Alberta Primary Care Networks (PCNs) are comprised of groups of family physicians and other health care professionals working together to provide comprehensive patient care to Albertans. To understand if the community health navigator program can be feasibly scaled and spread to PCNs across Alberta, we are expanding research to examine and evaluate community health navigation program implementation to other geographic areas and populations. This study expands the ENCOMPASS program of research to select Calgary West Central PCN primary care clinics. The current study employs the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to examine the scalability of the community health navigation program.

The objectives of this study are to (1) assess the impact of the intervention on the target population and health system (effectiveness); (2) explore the feasibility and appropriateness of practical intervention scale-up (reach, adoption, implementation, and maintenance), and (3) identify the required resources and infrastructure necessary to maintain and scale the intervention provincially.

The effectiveness of the community health navigator program will be studied using a two-armed, pragmatic, randomized controlled trial. This study will employ patient-level block randomization stratified by study site. Randomization will be concealed and computer-generated, and research staff will be blinded to block size. Primary outcomes will be assessed using administrative health data. Secondary outcomes will be measured using a patient health survey administered by a research assistant at baseline, 6 months, and 12 months. A concurrent qualitative study will provide contextual information on the effectiveness of the community health navigator program from patient, provider, and CHN perspectives. Process evaluation metrics and interviews with program stakeholders will inform the feasibility and sustainability of the community health navigator program in Alberta PCNs.

Being tested
Community Health Navigator Program
Keywords
Chronic Disease Management, Health Navigation, Health Navigator
Medical subject headings
Hypertension, Diabetes Mellitus, Type 2, Renal Insufficiency, Chronic, Myocardial Ischemia, Heart Failure, Pulmonary Disease, Chronic Obstructive, Asthma

What participants receive

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

  • Community Health Navigator ProgramBehavioural

    Also called ENCOMPASS Program

    Patients will be matched to a community health navigator (CHN) who will conduct a needs assessment to determine the frequency of meetings. A CHN may perform any of the following: providing information to a patient's health care provider, translation, advocating for the patient, connecting the patient with resources (e.g., social, financial, insurance), helping patients set health-related goals, facilitating health care referrals and appointments, and monitoring appointments. These activities may require the CHN to be physically present at appointments or have direct contact with the patient's health care provider. Goal setting and support will be provided in-person or over the telephone using motivational interviewing principles.

Study groups in NCT04790617
Study groupRoleWhat they receive
InterventionExperimentalCommunity health navigator program for six months.
Receives: Behavioral: Community Health Navigator Program
ControlNo interventionUsual health care.

What is being measured

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

  1. Acute care service use

    Rate of emergency department visits and hospital admissions based on administrative health data.

    Measured: Up to 36 months

Secondary outcomes (24)
  1. Health-related quality of life

    EuroQol EQ-5D-5L.

    Measured: Up to 12 months

  2. Patient experience of care

    11-item modified Patient Assessment of Chronic Illness Care (PACIC).

    Measured: Up to 12 months

  3. Patient activation

    10-item Patient Activation Measure (PAM-10), score and level.

    Measured: Up to 12 months

  4. Anxiety symptoms

    7-item Generalized Anxiety Disorder (GAD-7).

    Measured: Up to 12 months

  5. Depressive symptoms

    9-item Patient Health Questionnaire (PHQ-9).

    Measured: Up to 12 months

  6. Perceived social support

    8-item modified Medical Outcomes Study Social Support Survey (mMOS-SS).

    Measured: Up to 12 months

  7. Health literacy

    3-item Brief Screening Questions for Health Literacy.

    Measured: Up to 12 months

  8. General self-rated health

    1-item Self-Rated Health (SRH).

    Measured: Up to 12 months

  9. Household food security

    6-item Household Food Security Survey Module (HFSSM).

    Measured: Up to 12 months

  10. Smoking status

    Self-reported smoking status.

    Measured: Up to 12 months

  11. Weight

    Change in self-reported weight in kilograms or pounds.

    Measured: Up to 12 months

  12. Disease-specific intermediate health outcomes: Diabetes

    Change in mean glycosylated hemoglobin (A1C) based on laboratory data.

    Measured: Up to 24 months

  13. Disease-specific intermediate health outcomes: Hypertension

    Change in systolic blood pressure (SBP) in mmHg based on primary data collection.

    Measured: Up to 12 months

  14. Disease-specific intermediate health outcomes: COPD/asthma

    Exacerbations based on administrative health data.

    Measured: Up to 24 months

  15. Disease-specific intermediate health outcomes: Ischemic heart disease, chronic kidney disease, diabetes

    Appropriate use of a statin where indicated based on pharmaceutical information network (PIN) dispensation data.

    Measured: Up to 24 months

  16. Provider satisfaction

    Based on semi-structured interviews.

    Measured: Up to 12 months

  17. Patient experience

    Based on semi-structured interviews.

    Measured: Up to 12 months

  18. Continuity of care

    Provider attachment based on Usual Provider of Care (UPC) Index in Alberta practitioners claims file.

    Measured: Up to 24 months

  19. Primary Care Network (PCN) multidisciplinary team access

    umber of visits to multidisciplinary health team members based on PCN records.

    Measured: Up to 24 months

  20. Program costs

    Administrative, training, and operational costs of program, assessed through PCN financial records.

    Measured: Up to 24 months

  21. Physician costs

    Physician claims based on physician claims files.

    Measured: Up to 24 months

  22. Acute care costs

    Hospital admission and emergency department visit costs based on administrative health data.

    Measured: Up to 24 months

  23. All-cause mortality

    All-cause mortality rate based on administrative data.

    Measured: Up to 24 months

  24. Medication adherence

    ≥80% of days covered for medications in Care Plan based on pharmaceutical information network (PIN) dispensation data.

    Measured: Up to 24 months

Timeline

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

  1. First posted10 Mar 2021
  2. Study start1 Mar 2021
  3. Primary completion10 Nov 2022
  4. Study completion10 Nov 2023

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
The ENCOMPASS study will evaluate the effectiveness of a community health navigator program using a two-armed, pragmatic, randomized controlled trial. The intervention arm will receive the CHN program for six months. The control arm will receive their usual health care. This study will employ patient-level block randomization stratified by study site. Research staff will be blinded to block size. In the case where participants live together in the same residence, they will be randomly assigned to the same study arm.
Masking
None (open label)
Enrolment
183 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04790617
Sponsor's protocol ID
REB20-0009
Acronym
ENCOMPASS
Status last verified
May 2024
First submitted
13 Jan 2021
Last updated
23 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lehmann U, Sanders, D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs an impact on health outcomes of Using community health workers. Geneva: World Health Organization. 2007.

  • Najafizada SA, Bourgeault IL, Labonte R, Packer C, Torres S. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 Mar 12;106(3):e157-64. doi: 10.17269/cjph.106.4747.

    PubMed 26125243
  • Addressing chronic disease through community health workers: A policy and systems-level approach. Centers for Disease Control and Prevention. 2015.

  • Gutierrez Kapheim M, Campbell J. Best Practice Guidelines for Implementing and Evaluating Community Health Worker Programs in Health Care Settings. Sinai Urban Health Institute; Chicago, IL. 2014.

  • Kangovi S, Grande D, Trinh-Shevrin C. From rhetoric to reality--community health workers in post-reform U.S. health care. N Engl J Med. 2015 Jun 11;372(24):2277-9. doi: 10.1056/NEJMp1502569. No abstract available.

    PubMed 26061832
  • Burns ME, Galbraith AA, Ross-Degnan D, Balaban RB. Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions. Int J Qual Health Care. 2014 Aug;26(4):358-65. doi: 10.1093/intqhc/mzu046. Epub 2014 Apr 16.

    PubMed 24744082
  • Enard KR, Ganelin DM. Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. J Healthc Manag. 2013 Nov-Dec;58(6):412-27; discussion 428.

    PubMed 24400457
  • Herman D, Conover S, Felix A, Nakagawa A, Mills D. Critical Time Intervention: an empirically supported model for preventing homelessness in high risk groups. J Prim Prev. 2007 Jul;28(3-4):295-312. doi: 10.1007/s10935-007-0099-3. Epub 2007 Jun 1.

    PubMed 17541827
  • Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial. Am J Public Health. 2017 Oct;107(10):1660-1667. doi: 10.2105/AJPH.2017.303985. Epub 2017 Aug 17.

    PubMed 28817334
  • Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, Shannon RP, Long JA. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med. 2014 Apr;174(4):535-43. doi: 10.1001/jamainternmed.2013.14327.

    PubMed 24515422
  • Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, Gitlin LN, Han HR. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. Am J Public Health. 2016 Apr;106(4):e3-e28. doi: 10.2105/AJPH.2015.302987. Epub 2016 Feb 18.

    PubMed 26890177
  • Carrasquillo O, Lebron C, Alonzo Y, Li H, Chang A, Kenya S. Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial. JAMA Intern Med. 2017 Jul 1;177(7):948-954. doi: 10.1001/jamainternmed.2017.0926.

    PubMed 28459925
  • Morgan AU, Grande DT, Carter T, Long JA, Kangovi S. Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center. Am J Public Health. 2016 Nov;106(11):1958-1960. doi: 10.2105/AJPH.2016.303366. Epub 2016 Sep 15.

    PubMed 27631747
  • McBrien KA, Ivers N, Barnieh L, Bailey JJ, Lorenzetti DL, Nicholas D, Tonelli M, Hemmelgarn B, Lewanczuk R, Edwards A, Braun T, Manns B. Patient navigators for people with chronic disease: A systematic review. PLoS One. 2018 Feb 20;13(2):e0191980. doi: 10.1371/journal.pone.0191980. eCollection 2018.

    PubMed 29462179
  • Ali-Faisal SF, Colella TJ, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. Patient Educ Couns. 2017 Mar;100(3):436-448. doi: 10.1016/j.pec.2016.10.014. Epub 2016 Oct 17.

    PubMed 27771161

Questions about this trial

What is this clinical trial studying?

A study testing Community Health Navigator Program in people with Hypertension and Diabetes Mellitus, Type 2, run by University of Calgary at 1 site in Canada.

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 6 inclusion and 3 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: finished, as of the sponsor's last update on 23 May 2024. 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 Canada. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Acute care service use (time frame: Up to 36 months). 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 NCT04790617, which also lists 18 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 23 May 2024.

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