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Patient-facing eHealth technologies, such as online patient portals, connect patients with the healthcare system, help them access their health information, and support self-management of health conditions. This study tested an intervention to improve adoption and use of the My HealtheVet patient portal for diabetes management.
The goal of this small scale study is to test the feasibility of engaging Veterans in a supported adoption intervention to promote effective patient portal use in a sample of Veterans with uncontrolled Type II diabetes.
Participants were eligible for recruitment if they were Veterans age 18-85 who were actively receiving care at one of the study sites (as determined by having an upcoming scheduled appointment), had uncontrolled glucose (HbA1c >= 8.5%), and had either never used the VA patient portal or were inactive registrants who have not used the patient portal in the past 12 months. Participants who met these conditions and did not opt out of the study were randomized to one of four arms: 1) Encouragement I (brochure + mailed training guide), 2) Encouragement II (brochure + mailed training guide + invitation to group training), 3) Encouragement III (brochure + mailed training guide + invitation to group and one-on-one training), and 4) Comparison (standard patient portal enrollment brochure only). All arms received the standard My HealtheVet patient portal enrollment brochure along with an invitation to participate in the study. Those randomized to any of the Encouragement Arms received a mailed training guide. The My HealtheVet Training Guide for Veterans Living with Diabetes was designed in conjunction with Veteran co-investigators based on feedback from patients living with diabetes who were My HealtheVet users. It provided step by step guidance on how to use the features Veterans living with diabetes find most helpful with specific examples of use for diabetes self-management. Those in Encouragement Arm II were also invited to attend one of several group training sessions. Those in Encouragement III were invited to schedule a one-on one session to learn how to use the patient portal. Those in the comparison condition were asked during their interview if they would like a Training Guide mailed to them at the end of the trial, and those interested were mailed a Training Guide.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Encouragement Arm 1 | Experimental | Participants in this encouragement condition will receive a mailed brochure with basic My HealtheVet content and a training guide with (a) insights from other Veterans on how to use My HealtheVet for diabetes self-management, (b) step-by-step guidance for how to sign up for My HealtheVet and, (c) detailed guidance on how to learn to use key features. |
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| Encouragement Arm 2 | Experimental | Participants in this encouragement condition will receive the same brochure and training guide as Arm 1 but will also be offered optional attendance at one of several group training sessions. |
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| Encouragement Arm 3 | Experimental | Participants in this encouragement condition will receive the same as in Arm 2 (brochure, training guide, and group training offer) but will also be offered a one-on-one My HealtheVet training session. |
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| Brochure Only Comparison Arm | Other | The Comparison condition will only receive a mailed brochure with basic My HealtheVet content during the trial. (The training guide will be mailed to them after completion of the interview at the end.) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| My HealtheVet Brochure | Behavioral | Participants will receive a mailed brochure with basic My HealtheVet content. |
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| Measure | Description | Time Frame |
|---|---|---|
| Any My HealtheVet Patient Portal Use | This measure captures any use of MHV within 180 days of the brochure mailing, including use of prescription refills, secure messaging, Blue Button, or any other portal features. | Portal use within 180 days of initial brochure mailing |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Upgraded to a Premium My HealtheVet Portal Account | After registering for the portal, patients must confirm their identity and accept the terms and conditions of the portal in order to upgrade to Premium status which allows access to secure messaging, their VA appointments, and electronic health record extracts such as lab results, medical imaging and reports, clinical notes, and their VA health summary. Patients can access a limited subset of portal features, including online prescription refills, without upgrading to Premium. This measure captures whether a participant upgraded to a Premium account during the trial. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Stephanie L Shimada, PhD | VA Bedford HealthCare System, Bedford, MA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Bedford HealthCare System, Bedford, MA | Bedford | Massachusetts | 01730-1114 | United States | ||
| VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32440998 | Result | Robinson SA, Zocchi MS, Netherton D, Ash A, Purington CM, Connolly SL, Vimalananda VG, Hogan TP, Shimada SL. Secure Messaging, Diabetes Self-management, and the Importance of Patient Autonomy: a Mixed Methods Study. J Gen Intern Med. 2020 Oct;35(10):2955-2962. doi: 10.1007/s11606-020-05834-x. Epub 2020 May 21. | |
| 32706679 | Result |
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One patient was mistakenly randomized to an arm even though he was deceased shortly prior to enrollment because he met the eligibility criteria according to our databases, including having a future appointment scheduled. Fifteen patients from one site were incorrectly identified as not having used the portal in the 12 months prior to the trial and were excluded from the analyses.
Patients meeting eligibility criteria were identified from clinical records and mailed an invitation to participate in the study along with a My HealtheVet brochure and an information sheet describing the study. Initial invitations were sent out in June 2019 at Site 1 and in December 2019 at Site 2. Patients who did not opt out were enrolled and randomized into study arms in July 2019 and January 2020, respectively.
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| ID | Title | Description |
|---|---|---|
| FG000 | Brochure Only Comparison Arm | The comparison condition only received a mailed brochure with basic My HealtheVet content during the trial. After the completion of their interview, they were offered a copy of the training guide. |
| FG001 | Encouragement Arm 1 |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 18, 2020 |
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Participants were not explicitly told which group they were randomized to
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| My HealtheVet Training Guide for Veterans Living with Diabetes | Behavioral | Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features |
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| My HealtheVet Group Training | Behavioral | Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes |
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| My HealtheVet Individual Training | Behavioral | Participants will be invited to participate in a one-on-one training to learn how to use My HealtheVet to help manage their diabetes at a time of their convenience. |
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| 180 days from brochure mailing |
| Use of Online Prescription Refills | This measure captures whether the participant used the portal's online prescription refill feature at least once within 180 days of mailing the brochure. | 180 days from brochure mailing |
| Use of Secure Messaging | Patient used the secure messaging feature during the trial | 180 days from brochure mailing |
| Boston |
| Massachusetts |
| 02130-4817 |
| United States |
| Stewart MT, Hogan TP, Nicklas J, Robinson SA, Purington CM, Miller CJ, Vimalananda VG, Connolly SL, Wolfe HL, Nazi KM, Netherton D, Shimada SL. The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement. J Med Internet Res. 2020 Jul 17;22(7):e17744. doi: 10.2196/17744. |
| 34339500 | Result | Zocchi MS, Robinson SA, Ash AS, Vimalananda VG, Wolfe HL, Hogan TP, Connolly SL, Stewart MT, Am L, Netherton D, Shimada SL. Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. J Am Med Inform Assoc. 2021 Sep 18;28(10):2176-2183. doi: 10.1093/jamia/ocab115. |
| 34807834 | Result | Robinson SA, Netherton D, Zocchi M, Purington C, Ash AS, Shimada SL. Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis. JMIR Diabetes. 2021 Nov 19;6(4):e32320. doi: 10.2196/32320. |
Participants in this encouragement condition received a brochure about the My HealtheVet portal and were mailed a training guide with (a) insights from other Veterans on how to use My HealtheVet for diabetes self-management, (b) step-by-step guidance for how to sign up for My HealtheVet and, (c) detailed guidance on how to learn to use key features. |
| FG002 | Encouragement Arm 2 | Participants in this encouragement condition received the My HealtheVet brochure and training guide, but was also offered optional attendance at one of several group training sessions. |
| FG003 | Encouragement Arm 3 | Participants in this encouragement condition received the same encouragement as in Arm 2 (brochure, training guide and group training offer) but were also offered a one-on-one My HealtheVet training session. |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Brochure Only Comparison Arm | The comparison condition only received a mailed brochure with basic My HealtheVet content during the trial. After the completion of their telephone interview, they were offered a copy of the training guide. |
| BG001 | Encouragement Arm 1 | Participants in this encouragement condition received a brochure about the My HealtheVet portal and were also mailed a training guide with (a) insights from other Veterans on how to use My HealtheVet for diabetes self-management, (b) step-by-step guidance for how to sign up for My HealtheVet and, (c) detailed guidance on how to learn to use key features. |
| BG002 | Encouragement Arm 2 | Participants in this encouragement condition received the My HealtheVet brochure and training guide, but were also offered optional attendance at one of several group training sessions. |
| BG003 | Encouragement Arm 3 | Participants in this encouragement condition received the same encouragement as in Arm 2 (brochure, training guide and group training offer) but were also offered a one-on-one My HealtheVet training session. |
| BG004 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
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| Region of Enrollment | Count of Participants | Participants |
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| Rural Residence | Count of Participants | Participants |
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| Marital Status | Count of Participants | Participants |
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| Average HbA1c at baseline (2019) | Mean | Standard Deviation | % (DCCT units) |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Primary | Any My HealtheVet Patient Portal Use | This measure captures any use of MHV within 180 days of the brochure mailing, including use of prescription refills, secure messaging, Blue Button, or any other portal features. | Patients randomized to each arm who had not used My HealtheVet in the 12 months prior to randomization. At the second site, 15 people who should have been excluded were inadvertently included in the sample because the criteria of no secure messaging use in previous 12 months was mistakenly used instead of no patient portal use in the previous 12 months. We did not discover this until after the trial was complete because there were delays in receiving actual portal use data. | Posted | Count of Participants | Participants | Portal use within 180 days of initial brochure mailing |
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| Secondary | Patient Upgraded to a Premium My HealtheVet Portal Account | After registering for the portal, patients must confirm their identity and accept the terms and conditions of the portal in order to upgrade to Premium status which allows access to secure messaging, their VA appointments, and electronic health record extracts such as lab results, medical imaging and reports, clinical notes, and their VA health summary. Patients can access a limited subset of portal features, including online prescription refills, without upgrading to Premium. This measure captures whether a participant upgraded to a Premium account during the trial. | Posted | Count of Participants | Participants | 180 days from brochure mailing |
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| Secondary | Use of Online Prescription Refills | This measure captures whether the participant used the portal's online prescription refill feature at least once within 180 days of mailing the brochure. | Posted | Count of Participants | Participants | 180 days from brochure mailing |
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| Secondary | Use of Secure Messaging | Patient used the secure messaging feature during the trial | Posted | Count of Participants | Participants | 180 days from brochure mailing |
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Adverse events were collected for 180 days for each participant
Patient deaths during the trial were typically discovered from communication with family members when reaching out to participants by telephone to schedule a training session or interview. These deaths were unrelated to participation in the trial but were reported to the institutional review board when discovered.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Comparison Arm | The Comparison condition received a mailed brochure with basic My HealtheVet information. They were offered a training guide at the end of the study (after their interview). | 1 | 68 | 0 | 68 | 0 | 68 |
| EG001 | Encouragement Arm 1 | Participants in this encouragement condition received the mailed brochure and a training guide with (a) insights from other Veterans on how to use My HealtheVet for diabetes self-management, (b) step-by-step guidance for how to sign up for My HealtheVet and, (c) detailed guidance on how to learn to use key features. | 0 | 69 | 0 | 69 | 0 | 69 |
| EG002 | Encouragement Arm 2 | Participants in this encouragement condition received the brochure and the same training guide as Arm 1 but were also offered optional attendance at one of several group training sessions. | 4 | 68 | 0 | 68 | 0 | 68 |
| EG003 | Encouragement Arm 3 | Participants in this encouragement condition received the same as in Arm 2 (brochure, training guide and group training offer) but were also offered a one-on-one My HealtheVet training | 0 | 70 | 0 | 70 | 0 | 70 |
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Due to the COVID-19 pandemic, group and one-on-one sessions planned at the second site had to be converted to virtual sessions without a hands-on component. This led to lower participation in training sessions at this second site.
At the second site, 15 people who had portal activity in the previous year were inadvertently included. These 15 people were excluded from analysis of outcomes.
Only a subset of those enrolled in each arm completed the telephone interview.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Stephanie Shimada, PhD | Center for Healthcare Organization and Implementation Research (CHOIR) United States Department of Veterans Affairs VA Bedford Healthcare System | 781-687-2208 | Stephanie.Shimada@va.gov |
| Jul 2, 2021 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D000092862 | Psychological Well-Being |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
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| Male |
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| Black/African-American |
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| Latino |
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| Other |
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| Unknown/Missing |
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| Widowed |
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| Divorced/Separated |
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| Single |
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The a priori threshold for statistical significance was p=0.05. |
| Superiority |
| Chi-squared | 0.613 | The a priori threshold for statistical significance was p=0.05. | Superiority |
| OG002 | Encouragement Arm 2 | Participants in this encouragement condition will receive the same brochure and training guide as Arm 1 but will also be offered optional attendance at one of several group training sessions. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes |
| OG003 | Encouragement Arm 3 | Participants in this encouragement condition will receive the same as in Arm 2 (brochure, training guide, and group training offer) but will also be offered a one-on-one My HealtheVet training session. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes My HealtheVet Individual Training: Participants will be invited to participate in a one-on-one training to learn how to use My HealtheVet to help manage their diabetes at a time of their convenience. |
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| OG002 |
| Encouragement Arm 2 |
Participants in this encouragement condition will receive the same brochure and training guide as Arm 1 but will also be offered optional attendance at one of several group training sessions. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes |
| OG003 | Encouragement Arm 3 | Participants in this encouragement condition will receive the same as in Arm 2 (brochure, training guide, and group training offer) but will also be offered a one-on-one My HealtheVet training session. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes My HealtheVet Individual Training: Participants will be invited to participate in a one-on-one training to learn how to use My HealtheVet to help manage their diabetes at a time of their convenience. |
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Participants in this encouragement condition will receive the same brochure and training guide as Arm 1 but will also be offered optional attendance at one of several group training sessions. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes |
| OG003 | Encouragement Arm 3 | Participants in this encouragement condition will receive the same as in Arm 2 (brochure, training guide, and group training offer) but will also be offered a one-on-one My HealtheVet training session. My HealtheVet Brochure: Participants will receive a mailed brochure with basic My HealtheVet content. My HealtheVet Training Guide for Veterans Living with Diabetes: Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features My HealtheVet Group Training: Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes My HealtheVet Individual Training: Participants will be invited to participate in a one-on-one training to learn how to use My HealtheVet to help manage their diabetes at a time of their convenience. |
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