Addressing Contextual Factors in Chronic Disease Management in Minority Older Adults through Photo-based Patient-Clinician Communication

通过基于照片的患者与临床医生沟通解决少数民族老年人慢性病管理中的背景因素

• 批准号: 10542753
• 负责人: Jane Jih
• 金额: $ 17.48万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-11 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542753
• 关键词: 2 arm randomized control trial; Address; Adult; Affect; African American; Aging; Aleurites; Area; Asian; Asian Americans; Award; Caring; Cellular Phone; Chinese; Chronic Disease; Clinic; Clinic Visits; Clinical; Communication; Communication Barriers; Development Plans; Diabetes Mellitus; Diet; Diet Habits; Disease Management; Disparity; Elderly; Feedback; Glucose; Goals; Health; Health system; Individual; Intervention; Knowledge; Latino; Linguistics; Mentors; Minority; Mission; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient-Centered Care; Patients; Persons; Pharmaceutical Preparations; Population; Primary Care; Procedures; Protocols documentation; Randomized; Research; Research Personnel; Self Management; Social support; Standardization; Structure; Technology; Testing; Training; Visit; Work; World Health Organization; acceptability and feasibility; arm; career; career development; comorbidity; contextual factors; design; enhancing factor; ethnic minority; experience; fall risk; health care disparity; health disparity; health equity; human centered design; implementation science; improved; improved outcome; member; multi-ethnic; multi-site trial; multidisciplinary; multiple chronic conditions; older patient; participant retention; patient oriented; patient-clinician communication; primary care clinic; primary care setting; racial minority; recruit; skills; tool; usability

PROJECT SUMMARY AND ABSTRACT By 2050, 42% of the older U.S. population will be racial/ethnic minorities. Older minorities bear a substantial burden of multiple chronic conditions (MCC) and receive poorer quality of chronic disease management. Patient-clinician communication barriers are important contributors to disparities in care and outcomes of MCC. In particular, clinical visit communication about the context of people’s lives (i.e., contextual factors such as medication use, dietary habits, fall risk and social support) optimally informs MCC management and is vital to delivering patient-centered care. Yet, few patient-clinician communication interventions have included diverse older adults with MCC, and most do not address the interactions of aging, MCC and contextual factors that enhance or reduce health. A common scenario is the minority older adult with diabetes and concurrent comorbid conditions. The burden of self-management tasks related to diabetes (e.g., checking glucose, taking medications, adhering to diet) while simultaneously following care plans for other conditions can be overwhelming, particularly when care plans do not account for the context of patients’ daily lived experiences. The overarching goal of this proposal is to overcome disparities in patient-clinician communication among older minorities with MCC by developing a patient-centered technology-based communication intervention called Photo+Care. The premise of Photo+Care is that a picture is worth a thousand words, meaning that photos can promote efficient information exchange and activate patients to communicate their lived experiences to their clinicians, so they can develop patient-centered care plans together. Using smartphone cameras as a tool, Photo+Care will elicit and integrate 4 contextual factors (medication use, dietary habits, fall risk and social support) into primary care for older minority adults with MCC. Photo+Care will consist of a patient component, comprising: 1) brief training on how to take photos using a smartphone; and 2) standardized, structured and open-ended prompts to guide what kind of photos to take to describe 1 of the 4 contextual factors. The clinician component includes brief training on: 1) how to respond to photos shared by patients; and 2) how to discuss contextual factors elicited by the photos. The patient-clinician component is when patients briefly share select photos with clinicians during a clinic visit. The career goal of the candidate, Dr. Jane Jih, is to be a leader in the national mission to achieve health equity and a research expert on health disparities among older adults. Her short-term goals are to gain additional skills necessary to develop and test patient-centered interventions that improve outcomes for multiethnic and linguistically diverse older adults. To support her career development, Dr. Jih has assembled an exceptional multidisciplinary mentoring team including Dr. Christine Ritchie, a geriatrician with MCC expertise and Dr. Tung Nguyen, a national leader in Asian American health. This award will advance knowledge of patient-centered approaches to enhance the care of older adults, and allow Dr. Jih to receive additional training to become a leader in disparities and aging research.

项目摘要和摘要 到2050年，美国年龄较大的人口中有42％将是种族/族裔少数民族。少数族裔有实质性的 多种慢性病（MCC）的负担，并接受慢性疾病管理质量较差。 患者 - 斜沟通障碍是导致MCC护理和结果差异的重要贡献者。 特别是，关于人们生活背景的临床访问沟通（即，上下文因素，例如 使用药物，饮食习惯，跌倒风险和社会支持）最佳地告知MCC的管理，并且对 提供以患者为中心的护理。然而，很少有患者 - 智慧沟通干预措施包括潜水员 老年人患有MCC，大多数人没有解决衰老，MCC和上下文因素的相互作用 增强或减少健康。一个常见的情况是少数老年人患有糖尿病和并发 合并条件。与糖尿病有关的自我管理任务的燃烧（例如，检查葡萄糖，服用 药物，坚持饮食），同时遵循其他疾病的护理计划 压倒性的，尤其是当护理计划不说明患者日常生经历的背景时。 该提案的总体目标是克服老年人在患者 - 智慧交流中的分布 与MCC的少数民族通过开发以患者为中心的技术交流干预措施称为 照片+护理。照片+护理的前提是图片值得一千个单词，这意味着照片可以 促进有效的信息交流并激活患者，以将他们的现场经验传达给他们 临床医生，因此他们可以一起制定以患者为中心的护理计划。使用智能手机摄像机作为工具 照片+护理将引起和整合4个情境因素（使用药物，饮食习惯，跌倒风险和社会 支持MCC的老年少数民族成年人的初级保健。照片+护理将由患者组成， 完成：1）简要培训如何使用智能手机拍照； 2）标准化，结构化和 开放式的提示指导要描述四个上下文因素中的1张照片。临床医生 组件包括以下简短的培训：1）如何应对患者共享的照片； 2）如何讨论 照片引起的上下文因素。患者 - 临床医生的组成部分是患者短暂共享选择 在诊所访问期间与临床医生合影。候选人Jane Jih博士的职业目标是成为领导者 国家卫生平等的使命和老年人健康差异的研究专家。她 短期目标是获得开发和测试以患者为中心的干预措施所需的其他技能 改善多种族和语言上不同的老年人的结果。为了支持她的职业发展， JIH博士组建了一个卓越的跨学科指导团队，包括克里斯汀·里奇（Christine Ritchie）博士 具有MCC专业知识的老年医生和亚裔美国人健康的国家领导者Tung Nguyen博士。这个奖项 将促进以患者为中心的方法来增强老年人的护理知识，并允许JIH博士 要接受额外的培训，成为差异和衰老研究领域的领导者。