Personal Health Record-Facilitated Diabetes Self-Management Among Rural Veterans

对退伍军人医疗保健的预期影响：拟议的项目提供了一个潜在的解决方案， 加强退伍军人的自我管理的慢性疾病的条件，通过干预， 可访问的自我管理工具，VA的PHR -我的HealthVet，促进知识和技能建设 糖尿病的自我管理。拟议的方法为以下方面制定了灵活和可获得的战略： 增加知识，发展自我监控技能，建立自我效能，提高患者 赋能因此，积极引导使用MHV作为技能培养工具将促进采用适当的 自我监控行为。拟议的项目有助于产生一个更面向病人的过程中获得 以及医疗质量和疾病管理。此外，该项目将提供早期证据， 在弱势退伍军人群体中采用和使用MHV。 背景：退伍军人承担着不成比例的糖尿病诊断负担，患病率为24%， 全国8.3%。患者层面的因素占患者护理和健康管理的95%以上。差的患者 知识/信息和参与是造成最普遍差距的两个关键因素， 患者激活和依从性干预可能有助于减少的VA医疗保健系统 护理差异，但患者参与自我护理行为的比例很低。医疗保健系统有 建立个人健康记录（PHR），如My HealtheVet（MHV），使患者能够访问 他们自己的健康记录，获得健康信息，并与提供者沟通他们的疾病 条件本研究建议通过以下方式激活患者并改善患者糖尿病相关行为 开发一种适应性的简短MHV驱动的患者激活和自我护理干预，以增强DSM 技能（例如，体力活动，饮食，药物依从性和自我监测）在高风险，农村退伍军人。 目的：本研究的目的是：（a）采用简单的My HealthVet（MHV）干预， 增强其对糖尿病退伍军人的适用性，提高患者的激活和DSM技能;（B） 检验农村DSM技能简易MHV干预的可行性和初步效果 退伍军人;和（c）评估退伍军人对适应性简短MHV干预的经验，并确定 认识到的障碍、促进因素和推动因素，并评估更广泛传播的潜力。 方法：为了实现这些目标，我们将开发一种针对DSM的适应性简短MHV干预 skills. My HealthVet功能培训（设定目标、输入/跟踪数据、研究健康相关 信息、安全消息传递）将首先得到发展。我们将获得一个非随机样本， 来自社区的20名农村退伍军人，年龄45岁以上，患有糖尿病和高血压或高脂血症- 位于弗吉尼亚州查尔斯顿集水区的门诊诊所。干预将涉及最初的面对面 其他干预会话远程交付。此外，每周提醒（或助推器 消息）将通过MHV安全消息传递发送给每个参与者。所有参与者将接受 在基线和6周随访时进行评估。对于那些同意的人，半结构化的电话采访 将与研究参与者一起进行，以评估退伍军人学习和导航MHV的经验 通过干预，并评估可行性，易用性，并完善潜在的传播， 更广泛的观众。主要结局、MHV使用频率和满意度以及次要结局， 将在基线和第6周时评估所有参与者的DSM技能和临床指标的变化 随访定量分析将涉及采用率和混合效应模型。主要质量 分析将涉及认知访谈和半结构化访谈的话语分析。

Anticipated Impacts on Veterans Health Care: The proposed project offers a potential solution to strengthening Veterans' self-management of chronic disease conditions through intervention to an easily accessible, self-management tool, the VA's PHR - My HealtheVet that fosters the knowledge and skill-building aspects of diabetes self-management. The proposed approach creates flexible and accessible strategies for increasing knowledge, developing self-monitoring skills, building self-efficacy and enhancing patient empowerment. Thus, active orientation to the use of MHV as a skill-building tool will foster adoption of proper self-monitoring behaviors. The proposed project serves to yield a more patient-oriented process in access to and quality of care, and disease management. Furthermore, this project will provide early evidence to increase adoption and use of MHV in disadvantaged Veteran groups. Background: Veterans bear a disproportionate burden of diagnosed diabetes at a 24% prevalence compared to 8.3% nationally. Patient-level factors account for >95% of patient care and health management. Poor patient knowledge/information and participation are two key factors responsible for the most prevalent disparities in the VA healthcare system for which patient activation and adherence interventions may help to reduce disparities in care, but patients have a low rate of engagement in self-care behaviors. Healthcare systems have established personal health records (PHRs), such as My HealtheVet (MHV), that enable patients to access their own health records, obtain health information, and communicate with providers about their disease conditions. This study proposes to activate patients and improve patient diabetes-related behaviors through development of an adapted brief MHV-driven patient activation and self-care intervention that enhances DSM skills (e.g., physical activity, diet, medication adherence, and self-monitoring) in high-risk, rural Veterans. Objectives: The objectives of this study are to: (a) Adapt a brief My HealtheVet (MHV) intervention to enhance its appropriateness for Veterans with diabetes increase patient activation and DSM skills; (b) test feasibility and preliminary effectiveness of the adapted brief MHV intervention on DSM skills in rural Veterans; and (c) evaluate Veterans' experience with the adapted brief MHV intervention and identify perceived barriers, facilitators, and enablers of its use, and assess the potential for wider dissemination. Methods: To achieve these objectives, we will develop an adapted brief MHV intervention that targets DSM skills. Training for features of My HealtheVet (setting goals, entering/tracking data, researching health-related information, secure messaging) will first be developed. We will obtain a nonrandomized sample of at least 20 rural Veterans, age 45+ years, with diabetes and either hypertension or hyperlipidemia from community- based outpatient clinics in the Charleston VA catchment area. The intervention will involve an initial in-person session with the rest of intervention sessions delivered remotely. In addition, weekly reminders (or booster messages) will be sent to each participant through the MHV secure messaging. All participants will undergo assessments at baseline and at 6 weeks follow-up. For those who agree, semi-structured telephone interviews will be conducted with study participants to evaluate Veterans' experience with learning and navigating MHV through the intervention and to assess feasibility, ease of use, and refinement for potential dissemination to a broader audience. Primary outcomes, frequency of and satisfaction with MHV use, and secondary outcomes, change in DSM skills and clinical indicators, will be assessed in all participants at baseline and at 6 weeks follow-up. Quantitative analysis will involve rate of adoption and mixed effects models. The primary qualitative analysis will involve cognitive interviewing and discourse analysis of semi-structured interviews.