Using Smart Displays to Implement an Evidence-Based eHealth System for Older Adults with Multiple Chronic Conditions

使用智能显示器为患有多种慢性病的老年人实施循证电子医疗系统

• 批准号: 10467353
• 负责人: DAVID H GUSTAFSON
• 金额: $ 77.75万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-05 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10467353
• 关键词: Accounting; Address; Adopted; Adult; Age; Anxiety; Chronic; Clinic; Clinical; Communication; Competence; Control Groups; Development; Devices; Diabetes Mellitus; Elderly; Elements; Engineering; Fatigue; Funding; Geriatrics; Goals; Health; Health Care Costs; Health system; Healthcare; Healthcare Systems; Hearing; Hyperlipidemia; Hypertension; Intention; Internet; Intervention; Loneliness; Measures; Mediating; Mediator of activation protein; Medical; Medicare; Mental Depression; Motivation; Obesity; Outcome; Pain; Patients; Personal Satisfaction; Phase; Physical Function; Prediabetes syndrome; Primary Health Care; Procedures; Quality of life; Randomized; Randomized Clinical Trials; Reading; Research; Research Personnel; Science; Self Determination; Self Management; Services; Sleep disturbances; Symptoms; System; Technology; Testing; Time; Trees; Tremor; United States Agency for Healthcare Research and Quality; Universities; Vision; Visual; Voice; Walking; Wisconsin; Woman; arm; beneficiary; computer science; cost; eHealth; evidence base; expectation; experience; follow-up; health management; improved; intelligent personal assistant; intrinsic motivation; laptop; literacy; men; multiple chronic conditions; older patient; pressure; prevent; primary outcome; programs; randomized trial; response; secondary outcome; skills; social; success; theories; therapy design; tool; video chat

PROJECT SUMMARY / ABSTRACT In addition to their debilitating impact on health and well-being, multiple chronic conditions (MCCs) account for 90% of Medicare spending. Among beneficiaries, 65% have 3 or more conditions such as diabetes and hypertension, and 23% have 5 or more. MCCs are often addressed in primary care, where time pressures prevent focusing on self-management—although such skills are crucial for living successfully with MCCs. Our long-term goal is to improve health and self-management for these patients, while reducing healthcare costs. An AHRQ-funded P50 supported our development of Elder Tree (ET). That eHealth system was shown in a randomized trial to improve quality of life and health factors among older adults with MCCs who were high users of primary care. ET provides tools, motivation, and support to help patients manage their health. Despite positive results, many did not use ET extensively, a very common problem with health apps. Our central question is whether adapting and delivering ET with voice-controlled technology can increase ET use, thereby improving quality of life and health outcomes even more than ET on a laptop. Smart speakers, used by talking and listening rather than typing and reading, offer the tantalizing but unproven promise of being easy to use, which may in part explain why the technology is being adopted faster than the internet or TV. Smart displays raise expectations even higher by adding a visual element that enables the system to "show" as well as "tell." We propose an R61/R33 project including a randomized clinical trial involving 282 (after attrition) patients age 65+ with 5 or more chronic conditions, 3 of which must be hypertension, hyperlipidemia, obesity, diabetes, or pre-diabetes. In the proposed 12-month trial plus 6-month follow-up, patients will be randomly assigned to receive ET via a laptop (ET-Text) or a smart display (ET-Voice). The project has the following specific aims: Aim 1: During the R61 phase, continue and complete development of the platform and operational procedures for delivering ET to the smart display group. Aim 2: During the R33 phase, conduct a balanced randomized clinical trial to test these hypotheses: Primary outcome: ET-Voice (vs. ET-Text) patients will have better functional health (a measure including physical function, pain, fatigue, sleep disturbance, anxiety, and depression) over time. Secondary outcomes: ET-Voice (vs. ET-Text) patients will have better outcomes for loneliness, number of symptoms, and healthcare use over time. In addition, amount of ET use, ease of use, and usefulness will be higher for the ET-Voice (vs. ET-Text) group. Mediators: Effects of study arm on outcomes will be mediated by ET use at 6 months and by Self-Determination Theory constructs of competence, social relatedness, and intrinsic motivation. Moderators: ET-Voice (vs. ET-Text) will show greater improvements in the primary outcome for: those age 65-74 vs. 75+ years old, women vs. men, those with 8+ vs. 5-7 chronic conditions, and those with more physical barriers to technology use (e.g. tremors). We will explore whether these moderation effects are also observed for the secondary outcomes.

项目概要/摘要 除了对健康和福祉造成破坏性影响外，多种慢性病 (MCC) 还导致 医疗保险支出的90%。在受益人中，65% 患有 3 种或以上疾病，例如糖尿病和 高血压，23%有5个或更多。 MCC 通常在初级保健中解决，那里的时间压力很大 防止专注于自我管理——尽管这些技能对于成功地与 MCC 共存至关重要。我们的 长期目标是改善这些患者的健康和自我管理，同时降低医疗费用。 AHRQ 资助的 P50 支持我们开发 Elder Tree (ET)。该电子医疗系统显示在 旨在改善患有高 MCC 的老年人的生活质量和健康因素的随机试验 初级保健的使用者。 ET 提供工具、动力和支持来帮助患者管理自己的健康。尽管 尽管取得了积极的结果，但许多人并未广泛使用 ET，这是健康应用程序中非常常见的问题。我们的中央 问题是用语音控制技术改造和提供 ET 是否可以增加 ET 的使用，从而 比笔记本电脑上的 ET 更能提高生活质量和健康结果。智能音箱，通过说话来使用 倾听而不是打字和阅读，提供了诱人但未经证实的易​​于使用的承诺， 这可能部分解释了为什么该技术的采用速度比互联网或电视更快。智能显示器 通过添加视觉元素使系统能够“展示”和“讲述”，从而提高期望。 我们提出了一个 R61/R33 项目，包括一项涉及 282 名（自然减员后）年龄患者的随机临床试验 65+ 患有 5 种或以上慢性病，其中 3 种必须是高血压、高脂血症、肥胖、糖尿病或 糖尿病前期。在拟议的 12 个月试验加 6 个月随访中，患者将被随机分配到 通过笔记本电脑 (ET-Text) 或智能显示器 (ET-Voice) 接收 ET。该项目有以下具体目标： 目标1：在R61阶段，继续完成平台和操作流程的开发 用于将 ET 传送到智能显示组。目标 2：在 R33 阶段，进行平衡随机 检验这些假设的临床试验： 主要结果：ET-Voice（相对于 ET-Text）患者将会有更好的效果 功能健康（包括身体功能、疼痛、疲劳、睡眠障碍、焦虑和 抑郁）随着时间的推移。次要结局：ET-Voice（相对于 ET-Text）患者将获得更好的结局 随着时间的推移，孤独感、症状数量和医疗保健使用情况。此外，ET的使用量、易用性、 ET-Voice（相对于 ET-Text）组的有用性会更高。中介者：研究组对 结果将通过 6 个月时的 ET 使用和自决理论构建来调节 能力、社会关系和内在动机。主持人：ET-Voice（相对于 ET-Text）显示效果会更好 主要结局的改善：65-74 岁与 75 岁以上人群、女性与男性、8 岁以上人群 与 5-7 种慢性病以及对技术使用有更多身体障碍的人（例如颤抖）相比。我们将 探讨次要结果是否也观察到这些调节效应。