Leveraging mobile health technology to reduce avoidable healthcare utilization in persons with Alzheimer's Disease and Related Dementias in adult day centers

利用移动医疗技术减少成人日间中心阿尔茨海默病和相关痴呆症患者本可避免的医疗保健利用率

• 批准号: 10190468
• 负责人: Tina Sadarangani
• 金额: $ 16.74万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10190468
• 关键词: Access to Information; Acute; Address; Adoption; Adult; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Behavior Therapy; Caregivers; Caring; Categories; Clinical; Communication; Communities; Community Health Systems; Continuity of Patient Care; Country; Data; Dementia; Development; Early Diagnosis; Early Intervention; Elderly; Electronic Health Record; Elements; Emergency department visit; Enrollment; Family; Feedback; Focus Groups; Formal caregiver; Future; Goals; Growth; Health; Health Status; Health Technology; Health system; Healthcare; Hospital Costs; Hospitalization; Individual; Integrated Health Care Systems; Intervention; Interview; Knowledge; Low income; Maps; Medical; Medical Records; Medical emergency; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Minor; Mobile Health Application; Modeling; Notification; Nurses; Outcome; Patients; Persons; Positioning Attribute; Principal Investigator; Process; Provider; Public Health Practice; Quality of Care; Registered nurse; Research; Research Personnel; Resources; Scientist; Services; Social Workers; Statutes and Laws; Surveys; System; Technology; Testing; Time; Training; Treatment Efficacy; Triad Acrylic Resin; Tweens; United States; United States National Institutes of Health; Visual; Work; acceptability and feasibility; behavior test; care providers; chronic care model; community based care; community setting; cost; design; disparity reduction; eHealth; efficacy testing; experience; facsimile; feasibility testing; functional status; handheld mobile device; health care delivery; health care service utilization; health care settings; health information technology; improved; informal caregiver; innovation; interoperability; mHealth; novel; product development; programs; prototype; racial diversity; racial minority; smartphone Application; social; therapy development; user centered design

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoida- ble emergency department (ED) visits and hospitalizations. Adult day service centers (ADCs) provide commu- nity-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily as- sessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to communicate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve communication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an inde- pendent scientist who leads a research program that integrates care from ADCs and PCPs using mHealth in- terventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to ad- dress health care utilization disparities, developing mHealth interventions using user-centered design princi- ples, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) identify the key domains of an mHealth application intended to support communication be- tween ADCs, PCPs, and informal caregivers regarding the health-related needs of PLWD; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and in- formal caregivers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth applica- tion use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6-month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve standards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access information from their medical records using their preferred smartphone application. This study is innovative because it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the develop- ment of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.

项目摘要。居住在社区的痴呆症患者 (PLWD) 极易避免 ble 急诊科 (ED) 就诊和住院治疗。成人日间服务中心（ADC）提供交流 为越来越多的不同种族的残疾人提供基于实体的护理，其中大多数是低收入者。每日如- ADC 跨学科工作人员（包括注册护士、社会工作者）的评估和连续观察 工作人员和项目主管）支持及早发现 PLWD 的临床问题。然而，当急性 如果健康状况发生变化，希望及时通知初级保健提供者的 ADC 工作人员 （PCP）常常无法有效地做到这一点。在我之前的研究中，我发现 ADC 工作人员依赖传真或 用于传达紧急信息的语音信箱消息。这导致 PCP 延迟或不响应 并让轻微的健康问题升级为医疗紧急情况。随着 ADC 中 PLWD 的数量 增长，迫切需要加强 ADC 之间重要临床信息的沟通， PCP 和护理人员可减少昂贵的住院治疗和急诊就诊。移动医疗（mHealth）干预措施 已被证明可以改善各种医疗保健领域的沟通和临床信息交换 设置，但它们并不是为 ADC 设计的。我寻求 K23 奖项的目标是成为一名独立的 领导一项研究计划的悬而未决的科学家，该计划利用移动医疗技术整合 ADC 和 PCP 的护理 采取干预措施，减少 PLWD 中可避免的医疗保健利用差异。在经验丰富的支持下 跨学科指导团队，我将接受三个领域的培训：利用综合卫生系统来调整 解决医疗保健利用差异，利用以用户为中心的设计原则制定移动医疗干预措施 ples，以及设计和测试行为干预措施。经过必要的培训后，我将执行以下操作 具体目标：（1）确定旨在支持通信的移动医疗应用程序的关键领域 ADC、PCP 和非正式护理人员之间关于 PLWD 健康相关需求的讨论； (2)设计与测试 移动医疗应用程序的视觉布局，旨在支持 ADC、PCP 和内部人员之间的通信 残疾人的正式护理人员； (3) 开发并审查移动医疗应用的可行性和可接受性 ADC 工作人员、PCP 和非正式护理人员的使用，以减少 PLWD 的住院和急诊就诊 超过 6 个月的时间。我的研究结果将为未来的 R01 提案提供信息，以测试干预措施的有效性 一个完全可操作的移动医疗应用程序。这项研究意义重大，因为研究结果将用于改善 护理标准并减少 PLWD 的昂贵和创伤性结果。它还推动了立法 国家卫生信息技术协调员办公室要求患者能够访问 使用他们喜欢的智能手机应用程序从他们的医疗记录中获取信息。这项研究具有创新性 因为它利用了 ADC 的优势并结合了一线提供商的观点来为开发人员提供信息 开发一个以用户为中心的实用移动医疗应用程序，以整合护理并减少 PLWD 的差异。