High Touch and High Tech (HT2) Proposal: Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside
High Touch and High Tech (HT2) Proposal: Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside
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DOI：
10.2196/resprot.6355
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发表时间：
2016-10-01
影响因子：
1.7
通讯作者：
Huerta, Timothy R.
中科院分区：
文献类型：
--
作者：
McAlearney, Ann Scheck;Sieck, Cynthia J.;Huerta, Timothy R.
背景：对于有复杂护理需求的患者，参与疾病管理活动至关重要。慢性病几乎影响到美国的每一个人。代价是真实的、个人的和无处不在的。作为回应，患者经常寻求工具来帮助他们管理自己的健康。患者门户，即与电子健康记录捆绑在一起的个人健康记录，显示了作为患者珍视的工具的前景，并可以改善健康。虽然患者门户目前侧重于门诊体验，但俄亥俄州立大学韦克斯纳医疗中心(OSUWMC)已经部署了一个专门为住院患者体验设计的门户，该门户连接到出院后可用的门诊患者门户。虽然这种住院技术在美国只有一家医院在积极使用，但医疗保健设施目前正在投资于支持大规模部署所需的基础设施。危急时刻，如住院，可能会增加患者对其健康的关注。在这段时间里，患者可能会更多地参与到他们的护理中，尤其是出院后使用工具来管理他们的健康。有证据表明，加强患者自我管理可以更好地控制慢性病。目的：本研究的具体目的是：(1)研究高科技和高接触干预对患者报告的出院结果的独立影响，包括患者管理慢性病的自我效能感和护理满意度；和(2)进行混合方法分析，以确定为患者提供MyChart床边(MCB，高科技)和患者门户上的培训/教育，以及MyChart动态(MCA，High Touch)将如何影响与患者门户的接触并与长期结果相关。方法：我们建议的为期4年的研究采用混合方法研究(MMR)方法，对一项随机对照试验进行评估，研究高科技干预(MCB，住院门户)和伴随的High Touch干预(培训患者使用门户来管理他们的护理和病情)的有效性。这项研究衡量了为住院患者量身定做的患者门户网站如何通过以下方式改善患者体验和增加患者参与度：(1)改善患者在医院期间对护理过程的感知；(2)提高患者管理慢性病的自我效能；(3)促进出院后继续使用患者门户网站进行护理管理。此外，我们的目标是在患者出院后提高他们对可供门诊患者使用的门户(MCA)的使用。结果：这项研究得到了医疗研究和质量机构(AHRQ)的资助。研究正在进行中，预计将于2019年8月结束。结论：为患者提供实时的健康信息可能是改变提供医疗服务的方式的积极力量。有意义的使用策略要求最低限度地示范使用患者门户技术，最常见的情况是在门诊环境中。然而，随着跨越医疗过渡的技术的成熟，更需要了解患者门户如何转变医疗交付。通过与患者合作解决和扩展当前的技术，我们的研究旨在推进努力，增加患者在他们的护理中的参与度，并为其他医院如何整合类似的技术开发一个模板。
Background: For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the United States. The costs are real, personal, and pervasive. In response, patients often seek tools to help them manage their health. Patient portals, personal health records tethered to an electronic health record, show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center (OSUWMC) has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge. While this inpatient technology is in active use at only one other hospital in the United States, health care facilities are currently investing in infrastructure necessary to support large-scale deployment. Times of acute crisis such as hospitalization may increase a patient's focus on his/her health. During this time, patients may be more engaged with their care and especially interested in using tools to manage their health after discharge. Evidence shows that enhanced patient self-management can lead to better control of chronic illness. Patient portals may serve as a mechanism to facilitate increased engagement.Objective: The specific aims of our study are (1) to investigate the independent effects of providing both High Tech and High Touch interventions on patient-reported outcomes at discharge, including patients' self-efficacy for managing chronic conditions and satisfaction with care; and (2) to conduct a mixed-methods analysis to determine how providing patients with access to MyChart Bedside (MCB, High Tech) and training/education on patient portals, and MyChart Ambulatory (MCA, High Touch) will influence engagement with the patient portal and relate to longer-term outcomes.Methods: Our proposed 4-year study uses a mixed-methods research (MMR) approach to evaluate a randomized controlled trial studying the effectiveness of a High Tech intervention (MCB, the inpatient portal), and an accompanying High Touch intervention (training patients to use the portal to manage their care and conditions) in a sample of hospitalized patients with two or more chronic conditions. This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by (1) improving patients' perceptions of the process of care while in the hospital; (2) increasing patients' self-efficacy for managing chronic conditions; and (3) facilitating continued use of a patient portal for care management after discharge. In addition, we aim to enhance patients' use of the portal available to outpatients (MCA) once they are discharged.Results: This study has been funded by the Agency for Healthcare Research and Quality (AHRQ). Research is ongoing and expected to conclude in August 2019.Conclusions: Providing patients real-time access to health information can be a positive force for change in the way care is provided. Meaningful use policies require minimum demonstrated use of patient portal technology, most often in the ambulatory setting. However, as the technology matures to bridge the care transition, there is a greater need to understand how patient portals transform care delivery. By working in concert with patients to address and extend current technologies, our study aims to advance efforts to increase patients' engagement in their care and develop a template for how other hospitals might integrate similar technologies.