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

项目概要/摘要 除了对健康和福祉的破坏性影响外，多种慢性病（MCC）还造成了 医疗支出的90%。在受益人中，65%的人患有3种或3种以上的疾病，如糖尿病， 高血压，23%有5个或更多。MCC通常在初级保健中解决， 防止专注于自我管理-尽管这些技能对于成功地与MCC相处至关重要。我们 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支持我们开发接骨木（ET）。该电子健康系统在一个 一项随机试验，以改善老年MCC患者的生活质量和健康因素， 初级保健用户。ET提供工具，动机和支持，以帮助患者管理他们的健康。尽管 积极的结果，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，用语音控制技术调整和提供ET是否能增加ET的使用，从而 改善生活质量和健康结果，甚至超过笔记本电脑上的ET。智能扬声器，用于说话 和倾听，而不是打字和阅读，提供了诱人的，但未经证实的承诺，易于使用， 这也许可以部分解释为什么这项技术比互联网或电视更快地被采用。智能显示器 通过增加一个视觉元素，使系统能够“显示”和“告诉”，从而提高期望值。" 我们提出了一个R61/R33项目，包括一项随机临床试验，涉及282名（自然减员后）患者，年龄 65岁以上，患有5种或以上慢性疾病，其中3种必须是高血压、高脂血症、肥胖症、糖尿病，或 糖尿病前期在拟定的12个月试验加6个月随访中，患者将被随机分配至 通过笔记本电脑（ET文本）或智能显示器（ET语音）接收ET。该项目的具体目标如下： 目标1：在R61阶段，继续并完成平台和操作程序的开发 用于将ET传送到智能显示器组。目的2：在R33阶段，进行一项平衡随机化研究， 测试这些假设的临床试验：主要结果：ET-语音（与ET-文本）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 抑郁症）。次要结局：ET-语音（与ET-文本）患者的结局更好， 孤独，症状数量，以及随着时间的推移医疗保健的使用。此外，ET使用量、易用性、 并且对于ET-语音（相对于ET-文本）组，有用性将更高。媒介物：研究组对 结果将通过6个月时ET的使用和以下自我决定理论结构来介导： 能力、社会关系和内在动机。主持人：ET语音（与ET文本）将显示更大的 主要结局的改善：65-74岁与75岁以上，女性与男性，8岁以上 vs. 5-7慢性病，以及对技术使用有更多物理障碍的疾病（如震颤）。我们将 探索这些调节效应是否也在次要结果中观察到。

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.