Addressing Contextual Factors in Chronic Disease Management in Minority Older Adults through Photo-based Patient-Clinician Communication

通过基于照片的患者与临床医生沟通解决少数民族老年人慢性病管理中的背景因素

• 批准号: 10370303
• 负责人: Jane Jih
• 金额: $ 17.48万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-11 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10370303
• 关键词: Address; Adult; Affect; African American; Aging; Aleurites; Area; Asian; Asian Americans; Award; Caring; Cellular Phone; Chinese; Chronic Disease; Clinic; Clinic Visits; Clinical; Communication; Communication Barriers; Development Plans; Diabetes Mellitus; Diet; Diet Habits; Disease Management; Elderly; Feedback; Glucose; Goals; Health; Health system; Individual; Intervention; Knowledge; Latino; Lead; Linguistics; Mentors; Minority; Mission; Non-Insulin-Dependent Diabetes Mellitus; Participant; Patient-Centered Care; Patients; Persons; Pharmaceutical Preparations; Population; Primary Health Care; Procedures; Protocols documentation; Randomized; Randomized Controlled Trials; Research; Research Personnel; Self Management; Social support; Standardization; Structure; Technology; Testing; Training; Ursidae Family; Visit; Work; World Health Organization; acceptability and feasibility; arm; base; care outcomes; career; career development; comorbidity; contextual factors; design; enhancing factor; ethnic minority; experience; fall risk; health care disparity; health disparity; health equity; human centered design; implementation science; improved; improved outcome; member; multi-ethnic; multi-site trial; multidisciplinary; multiple chronic conditions; older patient; patient oriented; patient-clinician communication; primary care setting; racial and ethnic; recruit; skills; tool; usability

PROJECT SUMMARY AND ABSTRACT By 2050, 42% of the older U.S. population will be racial/ethnic minorities. Older minorities bear a substantial burden of multiple chronic conditions (MCC) and receive poorer quality of chronic disease management. Patient-clinician communication barriers are important contributors to disparities in care and outcomes of MCC. In particular, clinical visit communication about the context of people’s lives (i.e., contextual factors such as medication use, dietary habits, fall risk and social support) optimally informs MCC management and is vital to delivering patient-centered care. Yet, few patient-clinician communication interventions have included diverse older adults with MCC, and most do not address the interactions of aging, MCC and contextual factors that enhance or reduce health. A common scenario is the minority older adult with diabetes and concurrent comorbid conditions. The burden of self-management tasks related to diabetes (e.g., checking glucose, taking medications, adhering to diet) while simultaneously following care plans for other conditions can be overwhelming, particularly when care plans do not account for the context of patients’ daily lived experiences. The overarching goal of this proposal is to overcome disparities in patient-clinician communication among older minorities with MCC by developing a patient-centered technology-based communication intervention called Photo+Care. The premise of Photo+Care is that a picture is worth a thousand words, meaning that photos can promote efficient information exchange and activate patients to communicate their lived experiences to their clinicians, so they can develop patient-centered care plans together. Using smartphone cameras as a tool, Photo+Care will elicit and integrate 4 contextual factors (medication use, dietary habits, fall risk and social support) into primary care for older minority adults with MCC. Photo+Care will consist of a patient component, comprising: 1) brief training on how to take photos using a smartphone; and 2) standardized, structured and open-ended prompts to guide what kind of photos to take to describe 1 of the 4 contextual factors. The clinician component includes brief training on: 1) how to respond to photos shared by patients; and 2) how to discuss contextual factors elicited by the photos. The patient-clinician component is when patients briefly share select photos with clinicians during a clinic visit. The career goal of the candidate, Dr. Jane Jih, is to be a leader in the national mission to achieve health equity and a research expert on health disparities among older adults. Her short-term goals are to gain additional skills necessary to develop and test patient-centered interventions that improve outcomes for multiethnic and linguistically diverse older adults. To support her career development, Dr. Jih has assembled an exceptional multidisciplinary mentoring team including Dr. Christine Ritchie, a geriatrician with MCC expertise and Dr. Tung Nguyen, a national leader in Asian American health. This award will advance knowledge of patient-centered approaches to enhance the care of older adults, and allow Dr. Jih to receive additional training to become a leader in disparities and aging research.

项目总结和摘要 到2050年，42%的美国老年人口将是少数民族。老年少数群体承担着重大的 多重慢性病（MCC）的负担和接受慢性病管理质量较差。 患者与临床医生之间的沟通障碍是导致MCC的护理和结局差异的重要因素。 特别是，关于人们生活背景的临床访视沟通（即，背景因素，如 药物使用、饮食习惯、跌倒风险和社会支持）最佳地为MCC管理提供信息， 提供以病人为中心的护理。然而，很少有患者-临床医生沟通干预措施包括不同的 老年人与MCC，大多数没有解决的相互作用，MCC和上下文因素， 增强或减弱健康。一种常见的情况是少数老年糖尿病患者并发 合并症与糖尿病相关的自我管理任务的负担（例如，检查血糖，服用 药物，坚持饮食），同时遵循其他条件的护理计划， 压倒性的，特别是当护理计划不考虑患者的日常生活经验的情况下。 这项建议的首要目标是克服老年人之间的患者-临床医生沟通的差距 通过开发一种以患者为中心的基于技术的沟通干预， 照片+护理。Photo+Care的前提是一张图片胜过千言万语，这意味着照片可以 促进有效的信息交流，并激发患者将他们的生活经历传达给他们的家人。 临床医生，这样他们就可以共同制定以病人为中心的护理计划。使用智能手机摄像头作为工具， Photo+Care将引出并整合4个环境因素（药物使用、饮食习惯、跌倒风险和社交 支持）纳入初级保健的少数民族老年人与MCC。Photo+Care将包括一个患者组件， 包括：1）关于如何使用智能手机拍照的简短培训; 2）标准化，结构化， 开放式提示，指导拍摄哪种照片，以描述4个背景因素中的1个。临床医生 内容包括以下方面的简短培训：1）如何回应患者分享的照片; 2）如何讨论 照片引发的背景因素。患者-临床医生部分是当患者短暂地分享选择 在诊所访问期间与临床医生的照片。候选人Jane Jih博士的职业目标是成为 国家使命，以实现健康公平和研究专家对老年人的健康差距。她 短期目标是获得开发和测试以患者为中心的干预措施所需的额外技能， 改善多族裔和语言多样的老年人的成果。为了支持她的职业发展， 博士Jih组建了一个特殊的多学科指导团队，包括克莉丝汀里奇博士， 与MCC专业知识的老年病学家和东阮博士，在亚裔美国人健康的国家领导人。这个奖项 将推进以患者为中心的方法的知识，以加强老年人的护理，并允许Jih博士 接受额外的培训，成为差异和老龄化研究的领导者。