The COOP Chart System provides a very brief reliable method for measuring recording and managing patient function as part of routine clinical practice. Study Objective - to measure the beneficial effects of the COOP Chart System on the process and outcomes of care received by adult chronic disease patients. Design - a randomized trial. A 2X2 factorial design will be used to test the separate and combined effects of the two components of the COOP Chart System - COOP Charts for Measurement of Functioning and Health Status and a Management Module to assist patient care planning. Setting - rural east coast and urban west coast practices of 64 primary care physicians. Patients - 1600 competent adult out-patients meeting any of the following selection criteria: Age > 75, hospital discharge within one month, heart disease, or medication treated diabetic, respiratory, emotional or arthritic diagnoses. Intervention - intervention period of 18 months. Physicians will receive the 45 minute intervention within two weeks after completing patient entry. Physicians will be randomized to 1 of 4 groups. One group of physicians (Measurement for common functional problems. Another group (Measurement only) will receive training about COOP Chart use only. The third group (Management only) will be given the patient management plans and the final group (Control) will be told only about the data collection. Thereafter, at every study patient revisit. COOP Chart and COOP Chart System clinicians will be expected to measure and record patient function. Measurement - all study clinicians complete a standard encounter form after each study patient revisit. At baseline and at termination, patients will also record the degree of provider attention to their perceived health problems. Analysis - Aim #1: Determine the impact of the Chart System on the """"""""process"""""""" of care using these process variables: . New information found (as a consequence of use of the COOP Charts to measure functioning), . New management actions, . Agreement between patient and clinicians on problems identified and managed, and . Utilization of health care services.
Aim #2 : Determine the impact of the Chart System on the """"""""outcomes"""""""" of care using the outcome variables: . General health status and . Patient satisfaction. Logistic and least squares regression will be used to model the effects of the interventions on the process and outcome variables. We will be able to detect a small effect size of the experimental interventions (effect size 0.23) with 80% power at the 5% level. The covariates (control variables) are continuity of care, patient health status and life satisfaction at entry, and patient sociodemographics (age, gender, education, income), age of physician, type of practice and urban/rural setting.
