A Dartmouth-led research group, including investigators from Vanderbilt University Medical Center (VUMC) and the University of Texas Medical Branch (UTMB), has received a $3.3 million grant from the National Institute on Aging. In this NIH stage III ‘real world’ efficacy trial, investigators will compare the impact of sharing visit recordings to care as usual over 12 months in older adults with diabetes.
According to previous studies, up to 80 percent of clinic visit information is forgotten by patients immediately after seeing their healthcare provider. This presents a significant barrier to their ability to manage their conditions, especially if they are older and have comorbidities that lead to poor health outcomes.
“After visit summaries can improve recall, but concerns still exist about their readability, accuracy, and low patient usage,” says Paul Barr, PhD, an associate professor of 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 on the study along 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 Patient Safety & Quality Healthcare, UTMB.
A new strategy to augment the use of after visit summaries is to share visit audio recordings, says Barr. “Studies have shown that when patients receive an audio recording of a visit, 71 percent listen and 68 percent share it with a caregiver, resulting in greater recall,” he says. “However, despite growing interest, there is limited research on the impact of recording and sharing clinic visits on patient self-management ability, health outcomes, or healthcare utilization of older adults.”
In the five-year study, the researchers will conduct the REPLAY Trial in primary care 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 being done 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 care indicators, healthcare utilization, and clinician practice behavior. They will also ask if the effect of audio recordings on self-management is greater for individuals at highest risk of poor self-management, including those with less caregiver support, moderate to severe depression, lower health literacy, and high disease burden.
“This project allows us to fundamentally identify the impact of sharing visit recording with older adults and the mechanisms by which it impacts self-management and secondary outcomes,” states Barr.
Importantly, the project will utilize the expertise of scientists, clinicians, patients, and care partners across the three health systems.
The multidisciplinary study team includes Martha Bruce, PhD (Department of Psychiatry, Geisel); James O’Malley, PhD (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, CCRP (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 the investigators to move beyond prior studies that have been focused on single recordings of specialty care visits, says Barr. “And a trial 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 his colleagues hope to show that audio recording and sharing of clinic visits can have a significant and positive impact on the ability of older patients to manage their healthcare. “We expect that our findings from this project will inform future policy related to the use of audio recording as part of routine care and guide implementation strategies,” he says.
Founded in 1797, the Geisel School of Medicine at 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, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America’s leading medical schools, Dartmouth’s Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.