Evaluating Connected Health Approaches to Improving the Health of Veterans

背景 心血管疾病是导致退伍军人住院、发病率和死亡率的主要原因。许多 造成危险的因素之一是发生在卫生保健系统外部和其内部的健康行为 退伍军人的日常生活，如体力活动、肥胖、吸烟和服药依从性。连着 Health是一种使用移动技术远程监控健康结果和部署干预措施的模式 来改变行为。而联网的医疗设备可能有助于促进对 对于退伍军人的日常生活来说，他们可能不会单独推动行为改变以改善健康。来自以下方面的见解 行为经济学可以帮助设计围绕互联医疗设备的接洽战略， 利用个人倾向于更偏向于当下这一事实，过度重视小概率，以及 受后悔和厌恶损失等情绪的影响很大。退伍军人健康管理局 (VHA)是领先的互联医疗技术，以改善退伍军人的护理和健康，因为 退伍军人管理局互联健康中心就是一个例子。然而，人们对退伍军人的经历和 这些技术的成果。如果没有适当的设计，退伍军人使用互联医疗设备 可能会受到多重挑战和潜在的意想不到的后果。鉴于VHA的重要意义 对这些技术的投资，对全国退伍军人的潜在重大影响，以及 在VHA的卓越蓝图中，这些方法必须经过严格的测试 目标 为了解决这些问题，我将致力于以下研究目标：1)了解退伍军人的 对互联医疗设备的需求、障碍和机会进行透视；2)评估退伍军人 Way to Health的经验，这是一个已经在费城CMCVAMC使用的技术平台 集成互联的医疗设备，实现行为经济干预措施的自动化部署；3) 使用健康之路测试基于社会和财政激励的互联健康方法，以增加 退伍军人的体力活动，为研究人员发起的研究提案提供信息。 方法 我的第一项研究将使用混合方法来确定退伍军人在移动和联网方面的体验 健康技术，使用Way to Health、互联设备和社会激励进行为期4周的试点 进行干预以增加体力活动，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，测试的是社交媒体和社交媒体的组合 以及增加体力活动的财政激励措施。这项工作将为调查人员发起的研究提供信息 提议进行更大规模的多点临床试验。来自这项工作的见解将适用于其他健康行为 例如与吸烟、肥胖和服药依从性有关的问题。 对退伍军人健康的预期影响 有效地将行为经济学的见解与互联的医疗设备和 导致退伍军人日常生活中行为的改善可以对 退伍军人的健康。这项工作的洞察力可以被用来应对其他心血管疾病风险 高血压、糖尿病、肥胖和吸烟等因素，这些因素可能会进一步改善 全国范围内退伍军人的健康状况。

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.