Web-Based Simulated Patient Interviewing for Developing MI Skills for Health Care

描述(申请人提供)：糖尿病和心血管疾病的可改变的行为风险因素，这两种疾病是人类和金钱上代价最高的两种疾病，包括肥胖、缺乏体育活动、吸烟和过量饮酒。尽管医学界长期以来一直在转向支持行为风险因素变化的慢性护理模式，但初级保健临床医生通常不提供慢性护理模式的一个关键特征：以患者为中心的行为咨询。动机访谈(MI)是一种以患者为中心的循证咨询形式，当应用于糖尿病和心血管疾病的风险因素时，可以改善患者的结果。为了支持初级保健中健康行为改变的MI的传播，该领域需要低成本和高可获得性的方法来评估和培训许多学科的从业者以患者为中心的沟通。拟议的项目旨在开发一个以计算机为基础的系统，以支持医疗保健提供者，包括医疗保健专门的MI技能评估和一套模拟的患者培训案例，提供者可以使用这些案例来练习其MI技能。该系统将以网络为基础，极大地方便访问和实用。第一阶段的目标包括开发技能评估的原型和一个互动实践案例，与12名临床医生一起对实践案例进行可用性测试，并与24名初级保健提供者就技能评估的初始心理测量学性质进行试点研究。在第二阶段，将在随机试验中开发和评估完整的产品，以确定培训案例评估和培训效果的可靠性和有效性。鉴于糖尿病和心脏病带来的关键健康挑战，以及采用慢性护理和初级保健医疗家庭模式的广泛运动，我们预计对此类产品的需求将会很大。 公共卫生相关性：该项目将为医疗保健提供者学习激励性访谈开发在线培训支持资源。在美国，糖尿病等慢性疾病已经达到了流行的程度，但通过改变健康行为，基本上是可以预防和治疗的。通过更好地接受励志访谈培训，医疗保健提供者可能能够更好地帮助患者做出艰难的生活方式改变。

DESCRIPTION (provided by applicant): Modifiable behavioral risk factors for diabetes and cardiovascular disease, two of the most costly diseases in both human and monetary terms, include obesity, lack of physical activity, smoking tobacco and excess alcohol consumption. Despite a longstanding movement in the medical community towards models of chronic care to support changes in behavioral risk factors, primary care clinicians, in general, do not provide a key feature in chronic care models: patient-centered behavioral counseling. Motivational Interviewing (MI), an evidence-based form of patient-centered counseling, improves patient outcomes when applied to risk factors for diabetes and cardiovascular disease. To support dissemination of MI for health behavior change in primary care, the field needs low cost and highly accessible methods to both evaluate and train practitioners of many disciplines in patient-centered communication. The proposed project aims to develop a computer-based system to support healthcare providers consisting of a health care specific MI skills assessment and a suite of simulated patient training cases that providers can use to practice their MI skills. The system will be web-based to greatly facilitate access and utility. Phase I aims include developing a prototype of the skill assessment and one interactive practice case, conducting usability testing of the practice case with 12 clinicians and conducting a pilot study of the initial psychometric properties of the skill assessment with 24 primary care providers. In Phase II, the complete product will be developed and evaluated in a randomized trial to establish reliability and validity of the assessment and training effectiveness of the training cases. Given the crucial health challenge presented by diabetes and heart disease, as well as wide movement to adopt chronic care and primary care medical home models, we expect demand for such a product to be large. PUBLIC HEALTH RELEVANCE: This project will develop online training support resources for healthcare providers learning motivational interviewing. Chronic diseases such as diabetes have reached epidemic proportions in the US but are largely preventable and treatable with health behavior changes. With better access to training in motivational interviewing, healthcare providers may be better able to help patients make difficult lifestyle changes.