Evaluating Connected Health Approaches to Improving the Health of Veterans

评估改善退伍军人健康的互联健康方法

• 批准号: 10172952
• 负责人: Mitesh S. Patel
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172952
• 关键词: Address; Baseline Surveys; Behavior; Behavior monitoring; Cardiovascular Diseases; Caring; Characteristics; Clinical Trials Design; Country; Data; Devices; Diabetes Mellitus; Diet; Emotions; Goals; Health; Health Services Research; Health Technology; Health behavior; Healthcare; Healthcare Systems; Hospitalization; Human; Hypertension; Incentives; Individual; Information Technology; Intervention; Interview; Investigator-Initiated Research; Investments; K-Series Research Career Programs; Lead; Medical center; Mentorship; Methods; Modeling; Monitor; Morbidity - disease rate; Multi-Institutional Clinical Trial; Obesity; Outcome; Overweight; Patient Monitoring; Performance; Persons; Philadelphia; Physical activity; Premature Mortality; Probability; Randomized Clinical Trials; Regrets; Research; Research Personnel; Research Project Grants; Research Proposals; Risk Factors; Service delivery model; Site; Smoking; Social support; Structure; Surveys; Technology; Testing; Training; Veterans; Weight; Work; base; behavior change; behavioral economics; cardiovascular disorder risk; career; career development; design; experience; financial incentive; follow-up; health administration; improved; innovation; insight; mHealth; medication compliance; mobile computing; mortality; new technology; novel strategies; physical inactivity; population health; programs; randomized trial; skills; social; sociodemographics; telehealth; usability

Background Cardiovascular disease is the leading cause of hospitalization, morbidity, and mortality among veterans. Many of the contributing risk factors are health behaviors that occur outside of the health care system and within their everyday lives of veterans such as physical activity, obesity, smoking, and medication adherence. Connected health is a model for using mobile technologies to remotely monitor health outcomes and deploy interventions to change behavior. While connected health devices may help to facilitate the monitoring of behaviors within veterans' everyday lives, they alone may not drive behavior change toward improved health. Insights from behavioral economics can help to design engagements strategies around connected health devices that leverage the fact the individuals tend to be more present-biased, put undue weight on small probabilities, and are heavily influenced by emotions such as regret and loss aversion. The Veterans Health Administration (VHA) is a leader in pioneering connected health technologies to improve the care and health of veterans as exemplified by the VA Center for Connected Health. However, little is known about veterans' experiences and outcomes with these technologies. Without the appropriate design, veterans' use of connected health devices may be subject to multiple challenges and potentially unintended consequences. Given VHA's significant investment in these technologies, the potentially significant impact on veterans nationally, and the alignment with the VHA's Blueprint for Excellence, it is imperative that these approaches are rigorously tested Objectives To address these issues, I will aim to focus on following research objectives: 1) Understand veterans' perspectives of needs, barriers, and opportunities with connected health devices; 2) Evaluate veteran's experiences with Way to Health, a technology platform already being used at the CMCVAMC in Philadelphia to integrate connected health devices and enable automated deployment of behavioral economic interventions; 3) Use Way to Health to test social and financial incentive-based connected health approaches to increase physical activity among veterans to inform an investigator-initiated research proposal. Methods My first study will use a mixed-methods approach to identify veterans' experiences with mobile and connected health technologies, conduct a 4-week pilot using Way to Health, a connected device, and social incentive intervention to increase physical activity, and conduct semi-structured interviews to evaluate trial experiences. These findings will inform my second study, a 20-week randomized clinical trial testing combinations of social and financial incentives to increase physical activity. This work will inform an investigator initiated research proposal for a larger, multisite clinical trial. Insights from this work will be applicable to other health behaviors such as those related to smoking, obesity, and medication adherence. Anticipated Impact on Veterans' Health Approaches that effectively combine insights from behavioral economics with connected health devices and lead to improvements in behaviors within the everyday lives of veterans can have a significant impact on the health of veterans. Insights from this work could be leveraged to address other cardiovascular disease risk factors such as hypertension, diabetes, obesity, and smoking, which could lead to additional improvements in the health of veterans on a national scale.

背景 心血管疾病是退伍军人住院、发病和死亡的主要原因。许多 的贡献风险因素是健康行为，发生在卫生保健系统之外， 退伍军人的日常生活，如体力活动，肥胖，吸烟和药物依从性。连接 卫生是一种利用移动的技术远程监测卫生结果和部署干预措施的模式 来改变行为虽然连接的健康设备可能有助于促进监测内部的行为， 退伍军人的日常生活中，他们独自一人可能不会推动行为改变，以改善健康。的见解 行为经济学可以帮助设计围绕互联健康设备的参与策略， 利用个人倾向于更倾向于现在的事实，过度重视小概率， 受到诸如后悔和损失厌恶等情绪的严重影响。退伍军人健康管理局 (VHA)是开创互联健康技术的领导者，以改善退伍军人的护理和健康， 例如VA Center for Connected Health。然而，人们对退伍军人的经历知之甚少， 这些技术的成果。如果没有适当的设计，退伍军人使用连接的医疗设备 可能会面临多重挑战和潜在的意外后果。鉴于VHA的重要性 对这些技术的投资，对全国退伍军人的潜在重大影响，以及 根据VHA的卓越蓝图，必须对这些方法进行严格的测试 目标 为了解决这些问题，我将致力于以下研究目标：1）了解退伍军人 对互联医疗设备的需求、障碍和机遇的看法; 2）评估退伍军人的 体验健康之路，这是一个技术平台，已经在费城的CMCVAMC使用， 整合互联健康设备，实现行为经济干预措施的自动部署; 3） 使用健康之道测试基于社会和财务激励的互联健康方法， 退伍军人中的身体活动，以告知一个提案发起的研究建议。 方法 我的第一项研究将使用混合方法来确定退伍军人使用移动的和连接的体验 健康技术，使用Way to Health、联网设备和社会激励措施进行为期4周的试点 增加体力活动的干预措施，并进行半结构化访谈，以评估试验经验。 这些发现将为我的第二项研究提供信息，这是一项为期20周的随机临床试验， 以及增加体力活动的经济激励。这项工作将告知研究者发起的研究 一个更大的多中心临床试验的建议。这项工作的见解将适用于其他健康行为 例如与吸烟、肥胖和药物依从性相关的那些。 对退伍军人健康的预期影响 有效地将行为经济学的联合收割机见解与互联健康设备相结合的方法， 导致退伍军人日常生活中行为的改善， 退伍军人的健康。这项工作的见解可以用来解决其他心血管疾病的风险 高血压、糖尿病、肥胖和吸烟等因素，这些因素可能会导致 退伍军人的健康状况。