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

项目摘要。社区居住的痴呆症患者（PLWD）非常容易患上avoida- 急诊科（艾德）就诊和住院。成人日间服务中心（ADC）提供社区服务， 为越来越多的不同种族的艾滋病毒/艾滋病感染者提供基于社区的护理，其中大多数是低收入者。每天- 评估和连续观察由ADC的跨学科人员（包括注册护士，社会 工作人员和项目主任）支持早期发现PLWD的临床问题。然而，当急性 健康状况发生变化时，希望及时通知基层医疗服务提供者的ADC工作人员 （PCP）通常不能有效地做到这一点。在我之前的研究中，我发现ADC工作人员依赖传真或 语音邮件消息来传达紧急信息。这导致PCP延迟或不回复 让小的健康问题升级为医疗紧急情况。由于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，以减少昂贵的住院和艾德访问。移动的保健干预措施 已被证明可以改善各种医疗保健之间的沟通和临床信息交换 设置，但它们不是为ADC设计的。我的目标是成为一个独立的K23奖- 他是一位研究生科学家，领导了一项研究计划，该计划使用mHealth将ADC和PCP的护理整合在一起， 采取干预措施，以减少艾滋病病毒携带者中可避免的卫生保健利用差异。在经验丰富的 跨学科导师团队，我将获得三个方面的培训：使用综合卫生系统，以广告， 弥补医疗保健利用的差距，使用以用户为中心的设计原则开发移动健康干预措施， 设计和测试行为干预措施。经过必要的训练，我将执行以下任务 具体目标：（1）确定旨在支持通信的移动健康应用程序的关键领域， ADCs、PCP和非正式护理人员之间关于PLWD健康相关需求的研究;（2）设计和测试 mHealth应用程序的可视化布局，旨在支持ADC、PCP和内部 PLWD的正式照顾者;（3）开发和研究移动健康应用程序的可行性和可接受性， ADC工作人员、PCP和非正式护理人员在减少PLWD住院和艾德就诊方面的使用 在六个月的时间里。我的发现将为未来的R 01提案提供信息，以测试使用以下方法进行干预的有效性： 一个完全可操作的移动健康应用程序。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的昂贵和创伤性后果。它还推动立法， 国家卫生信息技术协调员办公室要求患者能够访问 使用他们首选的智能手机应用程序从他们的医疗记录中获取信息。本研究具有创新性 因为它利用了ADC的优势，并结合了一线供应商的观点，为发展中国家提供信息， 一个务实的以用户为中心的移动健康应用程序的一部分，以整合护理和减少PLWD的差距。

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.