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.

项目概要 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医疗系统，如图所示 改善患有多种慢性病的老年人的生活质量和健康因素的随机试验 （MCC），例如糖尿病和高血压。 MCC 在老年人中普遍存在且成本高昂，减少了 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自己的情绪 条件，但这些技能很少在初级保健中教授。 ET 为此类自助提供工具和支持 管理并解决所有 MCC 患者共有的沮丧、沮丧和孤独感， 与具体疾病无关。尽管取得了积极的结果，但许多研究参与者并未使用 ET 广泛而言，这是所有健康应用程序的一个问题。在另一项调查中，我们了解到超过 60% 的非用户 因为计算机太难用而放弃了 ET。语音控制的“智能”技术可能会解决这个问题 问题。智能音箱，通过说和听来使用，而不是打字和阅读，避免使用障碍 例如视力不佳、手抖、界面复杂等；它们被采用的速度比 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系统， 帮助用户记住内容并创建对要查看的媒体的访问。 该应用旨在测试声控技术扩展实施和应用的能力 持续使用经过验证的电子卫生系统。具体来说，我们建议测试老年人是否患有 由于易于使用，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 使用，而不是使用笔记本电脑版本的 ET。该提案有两个目标：1）开发智能系统平台（ET-SS） 2) 在 2 臂 RCT 中针对笔记本电脑 ET (ET-LT) 进行测试。该试验将 220 名 65 岁以上的患者随机分组，其中 4 名或 更多慢性病接受 8 个月的 ET-LT 或 ET-SS。我们假设： · ET-SS（相对于 ET-LT）患者在第 8 个月内将有更多的 ET 使用和更好的生活质量。 · 这些临床结果将得到改善：a) 30 天再入院率)，b) 药物依从性，以及 c) HbA1c、mg/dL、mmHg、FEV-1、BMI、PHQ-8、FAS-GFR 和简短疼痛量表的综合评分。 · 4 个月时 ET 的使用量将调节 8 个月时 ET 的影响（即 4 个月时使用更多） 月=8个月时的更大影响），以及负面情绪和自我决定理论的构建 能力、社会相关性和内在动机将调节 ET 使用的效果。 · ET-SS 将为女性和患有 6 种以上（相对于 4-5 种）慢性病的患者带来更好的结果。 我们，开发 ET 的研究人员，对电子医疗系统进行了大量随机对照试验，并发表了 广泛地。据我们所知，这将是第一个以智能系统为平台实施的大型RCT 并传播健康干预措施。结果可以使 ET 对老年人来说更容易获得和有效 患者，提高他们的生活质量，并为未来电子医疗创新的更有效交付指明道路。