Living Smartly with Diabetes: Using PWP and Mobile PWP for Self-Management

描述(由申请人提供)： 糖尿病是一种代价高昂且具有破坏性的慢性疾病，非洲裔美国人受到的影响不成比例。护理和自我管理的协调可以显著减轻这种疾病的经济和心理负担。使用最先进的通信和网络技术越来越多地被用于改善患者与提供者的沟通、疾病管理和自我护理行为。使用基于互联网的策略的患者门户网站(PWP)提供电子病历与患者健康记录的集成，以改善患者结果。智能手机是一种通信设备，可以提供即时访问互联网的健康信息。PWP与智能手机的集成为提供者与患者之间的安全和即时消息传递提供实时反馈，并立即访问与健康相关的信息。 路易斯·斯托克斯健康科学图书馆和霍华德大学医院糖尿病治疗中心(HH-DTC)都位于霍华德大学校园内，霍华德大学是一所历史悠久的黑人学院和大学。HH-DTC目前为其患者提供糖尿病PWP。在PWP的最初设计中，健康科学图书馆员没有参与。到目前为止，患者有效使用PWP存在几个障碍，如忘记密码，缺乏使用PWP教育部分等。这项研究将整合健康科学图书馆员、临床医生和计算机科学家的专业知识，以改进PWP。这项研究的目标是：(1)通过患者和提供者焦点小组消除障碍，改善PWP的使用；(2)在健康科学图书馆员的帮助下，利用焦点小组的反馈重新设计当前的PWP；(3)将智能手机与现有PWP整合，以增强患者/提供者的沟通和健康信息；以及(4)测量患者的激活程度，以改善糖尿病的自我管理，并在重新设计PWP-智能手机干预后降低血红蛋白A1c。 这项研究设计有两个方面。一是实施以患者为中心的糖尿病PWP再设计，二是非掩蔽性随机干预平行分配试验。试验参与者将被随机分为两个行为糖尿病干预组之一：(1)启用网络的智能手机教育PWP，或(2)使用PWP的标准糖尿病护理，但没有启用智能手机的PWP干预。研究将在HH-DTC进行。将从HH-DTC招募总共210名18岁或以上的非洲裔美国人男性和女性，以获得足够的能力来检测患者激活的差异，以加强糖尿病自我护理管理。网络活动的使用将使用谷歌分析进行监控。这项拟议的研究将接受霍华德大学机构审查委员会的彻底审查和监督。将有一个安全套接字层用于所有电子健康信息的安全，这将消除符合HIPPA关于患者便携性和隐私的规定的电子健康数据的安全漏洞。

DESCRIPTION (provided by applicant): Diabetes Mellitus is a costly and devastating chronic illness with African Americans disproportionately affected. Coordination of care and self-management can significantly reduce the economic and psychological burden of this disease. The use of state-of-the-art communications and networking technologies are increasingly being used to improve patient-provider communication, disease management, and self-care behavior. Patient web portals (PWPs) using internet-based strategies provide the integration of the electronic medical record with the patient health record for enhanced patient outcomes. Smartphones are communication devices that can provide instant access to the internet for health information. The integration of the PWP with a Smartphone provides real-time feedback for secure and instant messaging from provider to patient and immediate access to health related information. Louis Stokes Health Sciences Library and Howard University Hospital Diabetes Treatment Center (HUH-DTC) are both located on the campus of Howard University, a Historically Black College and University. The HUH- DTC currently provides a diabetes PWP to its patients. In the initial design of the PWP, health science librarians were not involved. To date, there are several barriers in patients effectively using the PWP such as forgotten passwords, lack of use of the PWP educational component, etc. This study will integrate the expertise of health science librarians, clinicians, and computer scientists for an improved PWP. The study goals are to: (1) improve PWP use by removing barriers through patient and provider focus groups, (2) redesign the current PWP using feedback from the focus groups with the assistance of health science librarians, (3) integrate the Smartphone with the existing PWP for enhanced patient/provider communication and health information and (4) measure patient activation for improved diabetes self-management along with reduction in hemoglobin A1c after the redesigned PWP-Smartphone intervention. The study design is two-fold. First, is to implement a patient-centered redesign of the diabetes PWP and the second, is a non-masked randomized interventional parallel assignment trial. Trial participants will be randomized into one of two behavioral diabetes intervention arms: (1) web-enabled Smartphone educational PWP, or (2) standard diabetes care with access to the PWP, but no Smartphone-enabled PWP intervention. The study will take place at the HUH-DTC. A total of 210 African American men and women 18 years or older will be recruited from HUH-DTC to achieve adequate power to detect differences in patient activation for enhanced diabetes self-care management. Web activity use will be monitored using Google Analytics. The proposed study will receive thorough review and oversight from the Institutional Review Board at Howard University. There will be a secure socket layer for security of all electronic health information that will eliminate security breaches of electronic health data meeting HIPPA regulations of patient portability and privacy.