A Dartmouth-led research group, including researchers from Vanderbilt University Medical Center (VUMC) and the University of Texas Medical Branch (UTMB), received a $3.3 million grant from the National Institute on Aging. In this NIH Stage III “real-world” efficacy trial, researchers will compare the impact of sharing visitation records on usual care over 12 months in older adults with diabetes.
According to previous studies, up to 80% of clinic visit information is forgotten by patients immediately after seeing their healthcare provider. This represents a significant barrier to their ability to manage their conditions, particularly if they are older and have comorbidities that lead to poor health outcomes.
“Post-visit summaries may improve recall, but concerns remain about their readability, accuracy, and low patient uptake,” says Paul Barr, PhD, associate professor at the Dartmouth Institute for Health Policy & Clinical Practice, and Center for Technology & Behavioral Health (CTBH) at the Geisel School of Medicine. Barr is co-principal investigator of the study with Kerri Cavanaugh, MD, MHS, associate professor and director of the Vanderbilt Center for Effective Health Communication, VUMC, and Meredith Masel, PhD, MSW, assistant professor and director of the Oliver Center for Safety of patients and quality of health care, UTMB.
A new strategy for increasing the use of summaries after the visit is to share audio recordings of the visit, says Barr. “Studies have shown that when patients receive an audio recording of a visit, 71% listen to it and 68% share it with a caregiver, resulting in better recall,” he says. “However, despite growing interest, there is little research on the impact of recording and sharing clinic visits on patients’ ability to self-manage, health outcomes, or healthcare utilization. seniors.”
During the five-year study, researchers will conduct the primary care REPLAY trial at three sites: Dartmouth Health, VUMC and UTMB. Patients will be randomized to receive visit audio recordings in addition to usual care versus usual care alone for all scheduled visits over one year, with assessments performed at baseline, one week, six months, and 12 months.
The study team will explore the impact of audio recordings on factors such as medication adherence, diabetes quality of life indicators, healthcare utilization and clinician practice behavior. They will also ask whether the effect of audio recordings on self-management is greater for people at higher risk of poor self-management, including those with less support from caregivers, moderate to severe depression, literacy in poorer health and a high disease burden.
“This project allows us to fundamentally identify the impact of sharing visitation records with older adults and the mechanisms by which it affects self-management and secondary outcomes,” says Barr.
Importantly, the project will utilize the expertise of scientists, clinicians, patients and care partners across all three health systems.
The multidisciplinary study team includes Martha Bruce, PhD (Department of Psychiatry, Geisel); James O’Malley, Ph.D. (The Dartmouth Institute); Elizabeth Carpenter-Song, PhD (Department of Anthropology, Dartmouth College); Craig Ganoe, MS (CTBH); James Goodwin, MD (UTMB); Parul Goyal, MD (VUMC); Hyunouk Hong (Dartmouth Health); Sunil Kripalani, MD MSc (VUMC); Lisa Oh, MS (CTBH); Isamar Ortiz, BA (UTMB); Susan Tarczewski, CPRC (CTBH); Sonya Williams, MS (VUMC); Adam Wright, PhD (VUMC), and patient partners Sheri Piper and Roger Arend.
Testing the routine use of audio recordings over time will allow investigators to go beyond previous studies that focused on single recordings of specialist care visits, Barr says. “And testing in real-world settings of patients with multiple morbidities, who are often excluded from trials, is novel and has greater validity,” he says.
Barr and her colleagues hope to show that audio recording and sharing of clinic visits can have a significant and positive impact on older patients’ ability to manage their healthcare. “We hope the results of this project will inform future policies around the use of audio recording in routine care and guide implementation strategies,” he said.
Founded in 1797, the Geisel School of Medicine in Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery and healing. The Geisel School of Medicine is renowned for its leadership in medical education, health policy and delivery science, biomedical research, global health, and creating innovations that improve lives around the world. As one of America’s leading medical schools, Dartmouth’s Geisel School of Medicine is committed to nurturing new generations of diverse leaders who will help solve our toughest health challenges.
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