Providing Specialty Care to Individuals With Parkinsonism Directly in Their Homes Via Web-based Video Conferencing— A Comparative Effectiveness Study
| Status: | Completed |
|---|---|
| Conditions: | Parkinsons Disease, Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 30 - Any |
| Updated: | 12/13/2017 |
| Start Date: | November 2011 |
| End Date: | April 2012 |
The investigators will conduct a two-arm, parallel group, randomized comparative
effectiveness study across two sites to increase specialty access and improve care for
individuals with Parkinsonism and their caregivers. Twenty individuals with Parkinsonism will
be recruited from Johns Hopkins University and the University of Rochester (approximately ten
from each site). They will then be randomized to either continue their usual in-person care
with a specialist or to receive care with their specialist via telemedicine in their home.
Following an in-person baseline/screening visit, approximately ten individuals in the first
arm (virtual house calls) will receive three visits with a movement disorder specialist via
telemedicine (using web-based video conferencing) in their home. Approximately ten
individuals in the second (control) arm will receive three in-person visits at an academic
medical center with the same specialists. Approximately two weeks after the completion of
each clinical visit, a nurse or coordinator will call the patient to call to address any
questions or ensure appropriate understanding of the recommendation (for both telemedicine
and control arms). Overall, the study - consistent with a national priority for comparative
effectiveness research - will compare the use of telemedicine to manage Parkinsonism to usual
care.
effectiveness study across two sites to increase specialty access and improve care for
individuals with Parkinsonism and their caregivers. Twenty individuals with Parkinsonism will
be recruited from Johns Hopkins University and the University of Rochester (approximately ten
from each site). They will then be randomized to either continue their usual in-person care
with a specialist or to receive care with their specialist via telemedicine in their home.
Following an in-person baseline/screening visit, approximately ten individuals in the first
arm (virtual house calls) will receive three visits with a movement disorder specialist via
telemedicine (using web-based video conferencing) in their home. Approximately ten
individuals in the second (control) arm will receive three in-person visits at an academic
medical center with the same specialists. Approximately two weeks after the completion of
each clinical visit, a nurse or coordinator will call the patient to call to address any
questions or ensure appropriate understanding of the recommendation (for both telemedicine
and control arms). Overall, the study - consistent with a national priority for comparative
effectiveness research - will compare the use of telemedicine to manage Parkinsonism to usual
care.
1. Abstract
The research's overall objective is to improve care for individuals with Parkinsonism.
Parkinsonism is clinically determined as the presence of at least 2 of the following: 1)
rest tremor, 2) bradykinesia, 3) cogwheel rigidity, or 4) difficulty with gait or
balance. The most common cause of Parkinsonism is Parkinson disease. Parkinson disease
is a chronic condition whose burden is growing both in the United States and globally.
However, access to specialty care is limited chiefly to urban areas and is frequently
inefficient. One way to remove geographic barriers to care is through the use of
web-based video conferencing (telemedicine).
To evaluate the study's aims, the investigators will conduct a seven-month randomized
controlled study of twenty patients with Parkinsonism across two sites to contrast the
comparative effectiveness of standard in-person specialty visits versus those conducted
via web-based video conferencing (telemedicine). It is hypothesized that these "virtual
house calls" will be feasible, clinically non-inferior to usual care, and economically
valuable. This research will expand the geographic scope of specialty care and provide a
national model for providing home-based, patient-centered, cost-effective care to those
with Parkinsonism anywhere they live.
2. Objectives (include all primary and secondary objectives)
The specific objectives of the study are as follows:
Aim 1: To evaluate the feasibility of providing specialty care to individuals with
Parkinsonism via web-based video conferencing (telemedicine) in their homes by calculating
the proportion of specialty visits completed as scheduled.
Hypothesis 1: Individuals receiving care via telemedicine in their homes will complete at
least 80% of their visits as scheduled.
Aim 2: To explore the clinical benefits, as measured by the change from baseline in quality
of life as measured by the Parkinson Disease Questionnaire 39 (PDQ-39).
Hypothesis 2: In this pilot study, the change in quality of life will be comparable between
the two groups.
Aim 3: To explore the economic benefit of providing specialty care via telemedicine in the
home.
Hypothesis 3: For patients and caregivers, travel and labor savings from receiving care in
the home will outweigh technology costs for telemedicine visits.
The research's overall objective is to improve care for individuals with Parkinsonism.
Parkinsonism is clinically determined as the presence of at least 2 of the following: 1)
rest tremor, 2) bradykinesia, 3) cogwheel rigidity, or 4) difficulty with gait or
balance. The most common cause of Parkinsonism is Parkinson disease. Parkinson disease
is a chronic condition whose burden is growing both in the United States and globally.
However, access to specialty care is limited chiefly to urban areas and is frequently
inefficient. One way to remove geographic barriers to care is through the use of
web-based video conferencing (telemedicine).
To evaluate the study's aims, the investigators will conduct a seven-month randomized
controlled study of twenty patients with Parkinsonism across two sites to contrast the
comparative effectiveness of standard in-person specialty visits versus those conducted
via web-based video conferencing (telemedicine). It is hypothesized that these "virtual
house calls" will be feasible, clinically non-inferior to usual care, and economically
valuable. This research will expand the geographic scope of specialty care and provide a
national model for providing home-based, patient-centered, cost-effective care to those
with Parkinsonism anywhere they live.
2. Objectives (include all primary and secondary objectives)
The specific objectives of the study are as follows:
Aim 1: To evaluate the feasibility of providing specialty care to individuals with
Parkinsonism via web-based video conferencing (telemedicine) in their homes by calculating
the proportion of specialty visits completed as scheduled.
Hypothesis 1: Individuals receiving care via telemedicine in their homes will complete at
least 80% of their visits as scheduled.
Aim 2: To explore the clinical benefits, as measured by the change from baseline in quality
of life as measured by the Parkinson Disease Questionnaire 39 (PDQ-39).
Hypothesis 2: In this pilot study, the change in quality of life will be comparable between
the two groups.
Aim 3: To explore the economic benefit of providing specialty care via telemedicine in the
home.
Hypothesis 3: For patients and caregivers, travel and labor savings from receiving care in
the home will outweigh technology costs for telemedicine visits.
Inclusion Criteria:
- The principal eligibility criteria for participants are the following: age greater
than 30, clinical diagnosis of idiopathic Parkinsonism, ability to converse in
English, ability and willingness to provide informed consent and complete study
requirements, and access to a computer with broadband internet.
Exclusion Criteria:
- The main exclusion criterion is a condition (e.g., prominent psychosis) that in the
investigator's judgment would preclude participation in a telemedicine visit.
Participants may identify a principal caregiver for optional participation in the
study.
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