Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults

使用智能设备为老年人实施循证电子医疗系统

• 批准号: 10457324
• 负责人: DAVID H GUSTAFSON
• 金额: $ 40万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10457324
• 关键词: Using; Smart; Devices; Implement; Evidence

PROJECT SUMMARY AHRQ previously funded the development of Elder Tree (ET), a laptop-based eHealth system shown in a randomized trial to improve quality of life and health factors among older adults with multiple chronic conditions (MCCs) such as diabetes and hypertension. MCCs are pervasive and costly among older adults, reducing quality of life and accounting for 90% of Medicare spending. Self-management can help patients control their conditions, but these skills are rarely taught in primary care. ET provides tools and support for such self- management and addresses the frustration, discouragement, and loneliness shared by all patients with MCCs, regardless of specific disease. Despite positive results, though, many study participants did not use ET extensively, a problem for all health apps. In a separate survey, we learned that more than 60% of non-users abandoned ET because the computer was too hard to use. Voice-controlled "smart" technology may solve this problem. Smart speakers, used by speaking and listening rather than typing and reading, avoid barriers to use such as poor vision, tremors, and interface complexity; they have been adopted at a rate faster than the Internet or TV, especially among older adults. Smart displays enhance the system with a visual element, helping users remember content and creating access to media meant to be viewed. This application proposes to test the ability of voice-activated technology to expand the implementation and sustain the use of a proven electronic health system. Specifically, we propose to test whether older adults with MCCs will use and benefit more from ET delivered by a smart system (speaker plus display), due to ease of use, than from a laptop version of ET. The proposal has 2 aims: 1) develop the smart system platform (ET-SS) and 2) test it against laptop ET (ET-LT) in a 2-arm RCT. The trial will randomize 220 patients age 65+ with 4 or more chronic conditions to receive for 8 months either ET-LT or ET-SS. We hypothesize that: · patients with ET-SS (vs. ET-LT) will have greater ET use and better quality of life in month 8. · these clinical outcomes will improve: a) 30-day hospital readmissions), b) medication adherence, and c) composite score of HbA1c, mg/dL, mmHg, FEV-1, BMI, PHQ-8, FAS-GFR, and Brief Pain Inventory. · the amount of ET use at 4 months will mediate the effects of ET at 8 months (i.e. greater use at 4 months=greater effects at 8 months), and negative affect and Self-Determination Theory constructs of competence, social relatedness, and intrinsic motivation will mediate the effects of ET use. · ET-SS will have better outcomes for women and for patients with 6+ (vs. 4-5) chronic conditions. We, the investigators who developed ET, have conducted numerous RCTs of eHealth systems and published extensively. To our knowledge, this will be the first large RCT of a smart system as a platform to implement and disseminate a health intervention. The result could make ET more accessible and effective for older patients, improve their quality of life, and point the way to more impactful delivery of future eHealth innovations.

项目摘要 AHRQ之前资助了Elder Tree（ET）的开发，这是一个基于笔记本电脑的电子健康系统， 一项旨在改善患有多种慢性疾病的老年人生活质量和健康因素的随机试验 （MCCs），如糖尿病和高血压。MCC在老年人中普遍存在且价格昂贵， 生活质量，占医疗保险支出的90%。自我管理可以帮助患者控制他们的 条件，但这些技能很少在初级保健中教授。ET为这样的自我提供工具和支持， 管理并解决所有MCC患者共同的挫败感、沮丧和孤独感， 无论具体疾病。尽管有积极的结果，但许多研究参与者并没有使用ET 广泛地说，这是所有健康应用程序的问题。在另一项调查中，我们了解到，超过60%的非用户 我放弃了ET，因为电脑太难用了。语音控制的“智能”技术可能会解决这个问题 问题.智能音箱，通过说和听而不是打字和阅读来使用，避免了使用障碍 例如视力差、震颤和界面复杂性;它们的采用速度比 互联网或电视，尤其是老年人。智能显示器通过视觉元素增强了系统， 帮助用户记住内容并创建对要观看的媒体的访问。 此应用程序提出测试语音激活技术的能力，以扩大实施和 持续使用经验证的电子健康系统。具体来说，我们建议测试老年人是否有 MCC将使用智能系统（扬声器加显示器）提供的ET并从中受益更多，因为它易于 使用，而不是从一个笔记本电脑版本的ET。该方案有两个目标：1）开发智能系统平台（ET-SS） 和2）在双臂随机对照试验中针对笔记本电脑ET（ET-LT）进行测试。该试验将随机分配220名年龄65岁以上的患者， 更多慢性疾病接受8个月ET-LT或ET-SS。我们假设： ·ET-SS（与ET-LT相比）患者在第8个月将有更多的ET使用和更好的生活质量。 ·这些临床结果将得到改善：a）30天的再次住院，B）药物依从性，以及c） HbA 1c、mg/dL、mmHg、FEV-1、BMI、PHQ-8、FAS-GFR和简明疼痛量表的综合评分。 ·4个月时ET的使用量将介导8个月时ET的作用（即4个月时更多的使用）。 8个月= 8个月时更大的影响），以及负面影响和自我决定理论的结构， 能力、社会关系和内在动机在教育技术使用效果中起中介作用。 · ET-SS对女性和患有6+（vs. 4-5）慢性疾病的患者有更好的结果。 我们，开发ET的研究人员，已经进行了许多电子健康系统的RCT，并发表了 广泛地。据我们所知，这将是第一个将智能系统作为平台来实施的大型RCT 并传播健康干预措施。结果可以使ET更容易获得和有效的老年人 患者，改善他们的生活质量，并为未来更有效地提供电子医疗创新指明了方向。