Effects of a Novel, Scalable, and Sustainable Patient Portal Intervention on Diabetes-Related Outcomes: A Pragmatic Randomized Controlled Trial

项目摘要/摘要 迫切需要有效的糖尿病自我管理干预措施，方便、可扩展、 可持续的，并能够满足不同患者和健康素养有限的患者的需求 不成比例地受到疾病的影响。根据我们的初步研究，我的糖尿病护理(MDC)可能会填补 这一关键差距是通过汇集糖尿病mHealth应用程序的一些最佳方面并结合 将它们整合到患者门户干预中，开发出可与各种电子健康系统互操作的工具 记录(EHR)，并直接集成到常规护理中，而不会为 医疗团队或需要额外的工作人员。MDC是一种多方面的患者门户干预，旨在 帮助患者更好地了解他们的糖尿病健康数据，并促进和支持自我管理。 由范德比尔特大学医学中心(VUMC)开发的MDC使用信息图表来方便用户 了解他们的糖尿病健康数据，包括激励策略和访问在线 患者支持社区，并提供识字水平适当和量身定做的糖尿病自我护理信息。 为了确保互操作性和优化可伸缩性，我们使用可替代的医疗应用程序构建了MDC， 快速医疗互操作性资源(FHIR上的SMART)上的可重用技术，使MDC能够 安装在美国各地的各种EHR平台上。我们的初步研究表明，MDC 可接受的，可行的，提高对糖尿病健康措施的理解，并增加患者的积极性。 建议研究的目标是：(1)将MDC对用户糖尿病健康数据的显示扩展到 血红蛋白A1C、血压、胆固醇和流感疫苗接种状况包括微白蛋白和BMI以及 通过创建西班牙语版本来改进访问；(2)评估扩展和增强的效果 关于糖尿病相关结果的MDC版本，同时通过将其集成到另一个版本来展示其可扩展性 卫生系统和在种族和种族多元化的情况下进行务实的随机对照试验 以及(3)通过研究因果介质来研究MDC的影响。建议数 工作很重要，因为少数族裔和健康素养有限的人更有可能 遇到糖尿病自我护理和科技使用方面的障碍。通过设计、测试和评估， 不同的患者群体，包括健康素养有限的患者和发展西班牙语的患者 版本，我们将推进对如何创建面向患者的健康技术的理解，以实现 广泛接受并解决健康不平等问题。通过利用FHIR上的SMART，我们的项目还将展示 通过实现和测试MDC而无需重建它，从而达到当前的技术水平，并将作为 未来基于患者门户的干预的模型。

Project Summary/Abstract There is an urgent need for effective diabetes self-management interventions that are convenient, scalable, sustainable, and able to meet the needs of diverse patients and those with limited health literacy that may be disproportionately affected by the disease. Based on our preliminary studies, My Diabetes Care (MDC) may fill this critical gap by bringing together some of the best aspects of diabetes mHealth apps and incorporating them into a patient portal intervention that was developed to be interoperable with a variety of electronic health records (EHRs) and that offers direct integration into routine care without creating additional work for healthcare teams or the need for additional staff. MDC is a multi-faceted patient portal intervention designed to help patients better understand their diabetes health data as well as promote and support self-management. Developed at Vanderbilt University Medical Center (VUMC), MDC uses infographics to facilitate users' understanding of their diabetes health data, incorporates motivational strategies and access to an online patient support community, and provides literacy level-appropriate and tailored diabetes self-care information. To ensure interoperability and optimize scalability, we built MDC using Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resource (SMART on FHIR) that allows MDC to be installed into a wide variety of EHR platforms across the U.S. Our preliminary studies suggest MDC is acceptable, feasible, improves understanding of diabetes health measures, and increases patient activation. The objective of the proposed research is to: (1) expand MDC's display of user's diabetes health data beyond hemoglobin A1C, blood pressure, cholesterol, and flu vaccination status to include microalbumin and BMI and enhance access by creating a Spanish-language version; (2) evaluate the effects of the expanded & enhanced version of MDC on diabetes-related outcomes while demonstrating its scalability by integrating it into another health system and conducting a pragmatic randomized controlled trial in an ethnically and racially diverse patient population, and (3) examine how the effects of MDC arise by studying causal mediators. The proposed work is important because racial/ethnic minorities and those with limited health literacy are more likely to experience barriers to diabetes self-care and technology use. By designing, testing, and evaluating, MDC in diverse groups of patients including those with limited health literacy and developing a Spanish language version, we will advance the understanding of how to create patient-facing health technologies to achieve broad uptake and address health inequities. By leveraging SMART on FHIR, our project will also demonstrate the current state of the art by implementing and testing MDC without needing to rebuild it and will serve as a model for future patient portal-based interventions.