Virtual house calls for Parkinson disease (Connect.Parkinson): study protocol for a randomized, controlled trial

Abstract

BackgroundInterest in improving care for the growing number of individuals with chronic conditions is rising. However, access to care is limited by distance, disability, and distribution of doctors. Small-scale studies in Parkinson disease, a prototypical chronic condition, have suggested that delivering care using video house calls is feasible, offers similar clinical outcomes to in-person care, and reduces travel burden.Methods/DesignWe are conducting a randomized comparative effectiveness study (Connect.Parkinson) comparing usual care in the community to usual care augmented by virtual house calls with a Parkinson disease specialist. Recruitment is completed centrally using online advertisements and emails and by contacting physicians, support groups, and allied health professionals. Efforts target areas with a high proportion of individuals not receiving care from neurologists. Approximately 200 individuals with Parkinson disease and their care partners will be enrolled at 20 centers throughout the United States and followed for one year. Participants receive educational materials, then are randomized in a 1:1 ratio to continue their usual care (control arm) or usual care and specialty care delivered virtually (intervention arm). Care partners are surveyed about their time and travel burden and their perceived caregiver burden. Participants are evaluated via electronic survey forms and videoconferencing with a blinded independent rater at baseline and at 12 months. All study activities are completed remotely.The primary outcomes are: (1) feasibility, as measured by the proportion of visits completed, and (2) quality of life, as measured by the 39-item Parkinson’s Disease Questionnaire. Secondary outcomes include measures of clinical benefit, quality of care, time and travel burden, and caregiver burden.DiscussionConnect.Parkinson will evaluate the feasibility and effectiveness of using technology to deliver care into the homes of individuals with Parkinson disease. The trial may serve as a model for increasing access and delivering patient-centered care at home for individuals with chronic conditions.Trial registrationThis trial was registered on clinicaltrials.gov on January 8, 2014 [NCT02038959].Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-465) contains supplementary material, which is available to authorized users.

National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers

“…The protocol details have been previously published. 5 The study was designed to enroll 200 individuals with Parkinson's disease and their care partners and has four specific aims:…”

“…Ten evaluated videoconferencing, but most were conducted in clinics. A subsequent literature search 5 found only six randomized controlled studies evaluating video visits directly into the home. With the exception of one multicenter spinal cord injury study, 6 most studies have been single center, short, and small.…”

National randomized controlled trial of virtual house calls for Parkinson disease

“…Only 6-almost all single-center, short, and smallevaluated physicians video conferencing directly into patients' homes. 7 Parkinson disease (PD) is an archetypal chronic condition that increases in incidence with age, 8 progressively disables those affected, impairs driving ability, 9 burdens caregivers, 7 increases health care costs, and benefits from specialized care. [10][11][12][13] However, over 40% of people with PD never receive care from a neurologist.…”

“…As previously described, 7,20 we conducted a 12-month randomized controlled trial investigating whether providing remote neurologic care into the homes of people with PD is feasible, beneficial, and valuable (Level III evidence). We compared usual care provided by local physicians to usual care augmented by 4 virtual visits from a remote neurologist.…”

“…A t test was performed to compare the adjusted treatment group means. 7 The interaction between treatment group and baseline score was also tested for significance. The robustness of the analysis to model assumptions was assessed using residual diagnostics and remedial measures.…”