N/A
N=407,869
ASCEND: ApproacheS to CHC ImplEmeNtation of SDH Data Collection and Action
Diabetes Mellitus
Bottom Line
View on ClinicalTrials.gov: NCT03607617 ↗Enrolled (actual)
407,869
Serious AEs
—
Results posted
Jan 2026
Primary outcome: Primary: Social Risk Screening — 2.45; 2.16 Rate Ratio (RR)
Study Design & Population
- Study type
- Observational
- Phase
- N/A
- Interventions
- SDH Tool (Other)
- Age
- Pediatric, Adult, Older Adult
- Sex
- All
- Sponsor
- Kaiser Permanente
- Primary completion
- Jan 2022
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Social Risk Screening |
2.45; 2.16 | — |
| SECONDARY Social Risk Referral |
1.33; 0.89 | — |
| SECONDARY Control of DM Risk Management Biomarkers: Blood Pressure (BP) |
1.35; 11.26; -0.90; 1.57 | — |
| SECONDARY Control of DM Risk Management Biomarkers: HbA1c |
-2.01; -6.74; -2.05; -6.46 | — |
| SECONDARY Control of DM Risk Management Biomarkers: LDL |
4.19; 7.33; 4.63; 5.61 | — |
| SECONDARY DM Key Tests (Screening, Percent up to Date) |
-7.50; -23.26; -9.92; -30.51; -8.53; -29.95 | — |
Summary
This work will test a set of strategies for helping community health centers (CHCs) routinely identify and take action on the SDH-related needs of patients with / at risk for DM using a stakeholder-driven process to develop EHR-based SDH data collection / summary tools for CHCs.
Eligibility Criteria
Inclusion Criteria
- Any persons who are at risk for type 2 diabetes
- May include some subjects with mental health conditions of various types; however, it is important to systematically address high DM /obesity risk in this population, because such patients may be at risk for elevated high DM /obesity risk and have often been excluded or underrepresented in previous research studies.
- Decisionally/cognitively impaired
- Economically/educationally disadvantaged
- Non-English Speakers
- Elderly
Exclusion Criteria
- Neonates of uncertain viability or nonviable neonates (up to 28 days post birth)
- Prisoners
Note: The investigators are not enrolling patients for this clinic-randomized study, but rather studying the uptake and impact of a set of EHR-based clinical decision support tools into regular care at the participating clinics. In this clinic-randomized trial, the intervention / randomization are clinic level. The intervention targets clinic processes that are part of the regular care patients receive, and will not require special visits.
Data sourced from ClinicalTrials.gov (NCT03607617). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.