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.

项目摘要/摘要 除了对健康和福祉的衰弱影响外，多种慢性病(MCC)也是 占医疗保险支出的90%。在受益者中，65%的人患有3种或3种以上的疾病，如糖尿病和 高血压，23%的人有5岁或更多。MCC通常在初级保健中解决，在那里时间压力很大 防止专注于自我管理--尽管这类技能对于成功地与MCC一起生活至关重要。我们的 长期目标是改善这些患者的健康和自我管理，同时降低医疗成本。 AHRQ资助的P50支持我们发展接骨木(ET)。该电子健康系统在一个 改善患有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他们的健康。尽管 积极的结果是，许多人没有广泛使用ET，这是健康应用程序的一个非常常见的问题。我们的中央 问题是，通过语音控制技术适应和交付ET是否可以增加ET的使用 改善生活质量和健康结果甚至比笔记本电脑上的ET更好。智能扬声器，用于通话 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， 这可能在一定程度上解释了为什么这项技术被采用的速度比互联网或电视更快。智能显示器 通过添加一个视觉元素，使系统既能“显示”又能“告诉”，从而提高了人们的期望值。 我们提出了一项R61/R33项目，其中包括一项随机临床试验，涉及282名(减员后)患者 65岁以上，有5种或5种以上慢性病，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个月试验和6个月随访中，患者将被随机分配到 通过笔记本电脑(ET-文本)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，继续完成平台和业务程序的开发 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(与ET-Text相比)患者将有更好的 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。次要结果：ET-Voice(与ET-Text)患者将有更好的预后 随着时间的推移，孤独、症状数量和医疗保健使用情况。此外，ET使用量、易用性 而对于ET-Voice(与ET-Text)组来说，有用性将更高。中介：研究性ARM对 结果将通过6个月时使用ET和自我决定理论的结构进行调节 能力、社会关系和内在动机。主持人：ET-Voice(与ET-Text)将显示更大 主要结果的改善：65-74岁与75岁以上者，女性与男性，8岁以上者 与5-7种慢性疾病相比，以及那些在使用技术方面有更多身体障碍的人(例如，震颤)。我们会 探索这些缓和效应是否也被观察到是次要结果。