Stratified Targeted Engagement From Primary Care to Physical Therapy (STEPPT)
Start Date
12/1/2025
Completion Date
2/28/2029
Summary
The goal of this clinical trial is to learn if a health system intervention called "Stratified Targeted Engagement from Primary Care to Physical Therapy (STEPPT)" can improve how often doctors refer Hispanic patients with spine pain to physical therapy (referral rate) and how often patients attend physical therapy after being referred (adherence rate). The main questions this study aims to answer are 1) does STEPPT improve physical therapy referral and adherence rates compared to usual care for Hispanic patients with spine pain who seek care in a Federally Qualified Health Center (FQHC) serving low income communities, and 2) how consistently do FQHC providers and staff deliver STEPPT to patients who may benefit? STEPPT will train doctors and other health care providers to educate participants on the benefits of physical therapy for spine pain and participants will receive culturally tailored handouts and videos to teach them about their spine pain and what to expect in physical therapy. Patients will also receive personalized assistance to schedule their physical therapy appointment and address potential barriers for attending the appointment.
Detailed Description
This study will examine the implementation and effectiveness of STEPPT for improving access and engagement of Hispanic patients with spine pain in physical therapy (PT) services at a Federally Qualified Health Center (FQHC) serving low-income communities near the United States-Mexico border. A pragmatic hybrid type I stepped wedge cluster randomized trial (SW-CRT) will be conducted to examine the effectiveness of STEPPT for increasing rates of PT referral and adherence as a primary aim. The study will also explore implementation outcomes to better understand the context of enacting a targeted intervention to engage medically underserved populations as a secondary aim. Nine FQHC Primary Care clinics (clusters) will be randomized to three implementation steps, with three clinics allocated per step, using a covariate-constrained randomization approach. To minimize imbalance between steps, allocation of clinics will be balanced with respect to clinic size and historical rates of PT referral and adherence in the year prior to allocation. For each candidate allocation, an imbalance score summarizing differences across steps will be calculated and the randomization procedure will be repeated to identify the allocation yielding the smallest overall imbalance score as the final stepped-wedge assignment. The three steps will transition from Usual Care (control) to STEPPT (intervention) at 6-month intervals. A 6-month baseline period of Usual Care for all clinics will precede the first date of cross over into STEPPT. Implementation and effectiveness outcomes will be assessed at 6-month intervals throughout the trial.
Eligibility Criteria
Age Range: 18 years to No maximum
Interventions
Engagement of clinic leadership (System Intervention - Usual Care)
Engagement of clinic leadership (System Intervention - STEPPT)
Patient Registry (System Intervention - STEPPT)
Delivery of Patient Education Materials (System Intervention - Usual Care)
Delivery of Patient Education Materials (System Intervention - STEPPT)
Referral Specialist Training (System Intervention - Usual Care)
Patient Health Navigator Training (System Intervention - STEPPT)
Care Navigation (System Intervention - STEPPT)
Care navigation audit and feedback (System Intervention - STEPPT)
Primary Care Provider training (Provider Intervention - STEPPT)
Nurse/Medical Assistant Training (Provider Intervention - STEPPT)
Provider feedback on PT referral and adherence (Provider Intervention - STEPPT)
Patient education on spine pain condition (Patient Intervention - Usual Care)
Patient education on spine pain condition (Patient Intervention - STEPPT)
Patient Education on Physical Referral by Providers (Patient Intervention - Usual Care)
Patient Education on Physical Referral by Providers (Patient Intervention - STEPPT)
Electronic Patient Education on Physical Therapy Referral (Patient Intervention - STEPPT)
Patient education on physical therapy referral by Referral Specialist (Patient Intervention - Usual Care)
Patient education on physical therapy referral by Patient Health Navigator (Patient Intervention - STEPPT)
Care Navigation (System Intervention - Usual Care)
Monitoring of PT referral and adherence rates (System Intervention - STEPPT)
Monitoring of PT referral and adherence rates (System intervention - Usual Care)
Conditions
Locations
Family Health Centers of San Diego
San Diego, California 92182
United States