Senior Health Clinic Outcome Study - Participant Recruitment & Data Collection

Ron Stock, MD, Principal Investigator for the project, met with the physicians of the Senior Health & Wellness Center, PeaceHealth Medical Group, Health Associates of Peace Harbor and South Lane Medical Group to describe the research study and review the patient recruitment materials. The physicians all agreed to have their patients contacted for potential participation in the research study and co-signed letters with Dr. Stock for the initial patient recruitment packets. The patient recruitment packets included the introductory letter, a HART screen for the patient to complete, an Intent to Participate form, a free membership flyer to Senior Class health and education programs and a postage paid return envelope.

Initial patient screening criteria included: 1) 66+ years of age at baseline and 2) Medicare Fee for Service as the payor. Only patients meeting these criteria and receiving some level of physician care within the previous 12 months (May 2000 to May 2001), were selected for the prospect list. The original prospect list included 3,470 PeaceHealth Medical Group patients, 1,470 Health Associates of Peace Harbor patients, 1,322 South Lane Medical Group patients, and 458 Senior Health & Wellness Center patients. A decision was made to include additional patient prospects for the Senior Health and Wellness Center by adding a cost-based Medicare insurance plan to increase the prospect list to 736 patients. From the PeaceHealth Medical Group, Health Associates of Peace Harbor, and South Lane Medical Group prospect list, we randomly selected and mailed packets to 2,000 PeaceHealth Medical Group patients, 1,000 Health Associates of Peace Harbor patients, and 1,000 South Lane Medical Group patients. All 736 Senior Health & Wellness Center patients were mailed a packet. A total of 4,736 patient recruitment packets were mailed out the week of June 18, 2001. Reminder postcards were sent three weeks after the original recruitment packets. All Senior Health & Wellness Center potential study participants who had not responded were called and personally asked to participate.

The initial response rate did not yield a sufficient sample for each of the three groups. Additional patient recruitment packets were mailed to the remaining prospects for PeaceHealth Medical Group, Health Associates of Peace Harbor, and South Lane Medical Group. In August and September 2001, every eligible new patient at the Senior Health & Wellness Center was talked with prior to their scheduled appointment and asked to participate in the study. In October 2001, a group visit approach to recruit patients at the Senior Health and Wellness Center was implemented. An additional 191 recruitment packets were given to Senior Health & Wellness Center patients bringing the total patients contacted to 927. Both the individual meeting and group visit approach were very successful and resulted in the recruitment of approximately 150 study participants. Patient Informed Consents were sent to all patients who agreed to participate in the study. Only those patients who returned a signed Patient Informed Consent were interviewed for the study.

GROUP	Packets Sent	Informed Consents Sent	Informed Consents Received	Baseline Interviews Completed
SHWC	927	519	478	438
PHMG	3318	1035	792	755
SL/HA	2619	656	546	518
TOTALS	6864	2210	1816	1711

Potential caregiver study participants were identified using questions answered in the HART screen. The potential caregiver study participants were contacted by telephone to request their participation and a Caregiver Informed Consent document was sent for their signature. All those non-paid caregivers who signed a Caregiver Informed Consent were contacted by phone to complete a survey of their caregiver involvement, satisfaction with care and the Caregiver Burden Inventory. Caregiver telephone interviewing began December 26, 2001.

The project team selected Oregon Survey Research Laboratory (OSRL) at the University of Oregon as the data collection sub-contractor for the project. The project team participated in the survey scripting and training of the telephone interviewers. Pre-testing of the telephone survey was done with 8 patient prospects not randomly selected to be in the research study. Sarah Donelson, MA, and Ron Stock, MD, met with all the OSRL telephone surveyors to review the instruments and prepare them for potential special needs of the older adult participants.

The collection of study participant baseline data began on September 19, 2001. There were 123 interviews completed in September 2001, 1433 interviews completed in October 2001, 143 interviews completed in November 2001 and 21 completed in December 2001. The dropout rate, after receiving a signed patient informed consent, was 6 percent. Reasons for not completing the survey were 1) the participant’s clinical status changed and was no longer able to complete a telephone survey (in several instances a proxy responder was found), 2) the participant died or moved from the area, and 3) the participant was unable to adequately complete the survey due to hearing problems. In most instances, the participant was able to complete the survey through a “relayer” or by arranging a face-to-face survey interview with an OSRL staff person. A total of 7 face-to-face interviews were completed. Proxies were used to complete the survey in 34 cases. All efforts, however, were made to have the participant complete the survey on their own.

Participant Six-Month Data Collection
An updated study participant list, including address or phone number changes, requests to be removed from the study or the death of a participant, was sent to the Oregon Survey Research Laboratory (OSRL) prior to the six-month data collection that began April 1, 2002. Participant interviews were completed May 24, 2002.

The six month interviews completed by group were 409 for the Senior Health & Wellness Center participants, 712 for the PeaceHealth Medical Group participants, 484 for South Lane and Health Associates of Peace Harbor participants and 9 participants yet to be assigned to a group.

Participant 18-Month Data Collection
Data collection at 18 months began April 1, 2003 and was completed June 2003. A total of 1,427 interviews were completed. The attrition rate from the 6-month data collection to the 18-month data collection was 10.9%. The attrition rated from baseline data collection to the 18-month data collection was 16.4%.

Participant 30-Month Data Collection
Data collection at 30-months began April 1, 2004, and was completed June 4, 2004. A total of 1319 interviews were completed. The attrition rate from the 6-month data collection to the 18-month data collection was 10.1%. The attrition rate from 18-month data collection to 30-month data collection was 8.2%. The attrition rate from baseline data collection to the 30-month data collection was 22.7%.

Study participant utilization and cost data, per CMS database, will be obtained from OMPRO. Baseline data will be collected for the 12-month period beginning October 1, 2000, and ending September 30, 2001. Subsequent data for study participants will be collected for the 6-month period beginning October 1, 2001, and ending March 31, 2002, the 18-month period beginning April 1, 2002, and ending March 31, 2003, and the 36-month period beginning April 1, 2003, and ending September 31, 2004. There is a six-month waiting period to obtain data from OMPRO to assure all utilization and cost data has been submitted to Medicare and OMPRO. Cost data will be analyzed for all participants who signed a patient informed consent. Those who signed the patient informed consent but were unable to complete or refused to complete the survey interview will be evaluated separately from participants who completed the survey interview. Baseline data from CMS year 2000 and 2001 Standard Analytical Files were received from OMPRO in May 2004. CMS 2002 data was requested in June 2004.

Caregiver Baseline Data Collection
Caregiver telephone interviewing began December 26, 2001 and was completed January 18, 2002. A total of 124 caregivers were interviewed. Two caregivers have withdrawn from the study and one caregiver name was a duplicate leaving 121 potential caregivers for the six-month data collection.

Caregiver 6-Month Data Collection
A total of 106 caregivers were interviewed at 6 months and data collection was completed July 2002. Attrition rate from baseline is 14 %.

Caregiver 18-Month Data Collection
Data collection occurred in July 2003. A total of 86 interviews were completed. The attrition rate from the 6-month data collection to the 18-month data collection was 3.4%. The attrition rate from baseline data collection to the 18-month data collection was 17.9%.

Caregiver 30-Month Data Collection
Data collection began in July 2004. A total of 57 interviews were completed. The attrition rate from baseline to the 30-month data collection was 54%.

Group	Baseline	6-months	18-months	30-months
Senior Health Center	438	408	353
Comp I	755	711	650
Comp II	518	483	432
Caregiver Data Collection	124	106	86	57