Improving Diabetes Care through Effective Personalized Patient Portal Interactions

摘要 目前已有300多万退伍军人采用了退伍军人患者门户My HealtheVet(MHV)，尽管实际情况如此 门户的使用差异很大，我们几乎没有关于如何最好地改进门户功能的数据 患者结果，或有效利用是否因子组不同而异。我们将努力定义有效的使用，使用 临床和管理数据、安全消息编码、患者调查以及与 丰富的MHV经验。将利用这项工作的经验教训来完善干预措施，以支持有效的 使用MHV门户功能进行慢性病管理。我们选择将我们的研究固定在一个 特殊病区：2型糖尿病，一种影响许多退伍军人的复杂疾病，与 严重的精神和身体并存、并发症和负面后果，需要高水平 自我管理的能力。 在全国糖尿病未得到控制的退伍军人样本中，AIMS 1和2使用队列嵌套病例- 控制设计，以生成必要的信息，使干预措施个人化，并定义有效使用 病人入口。AIM 3是一项旨在测试MHV支持的收养干预的小规模实验。 我们的具体目标是： 目标1.为特征选择和个性化干预产生新的信息。 在患有未得到控制的2型糖尿病的退伍军人的全国纵向队列中，我们将测试 患者门户工具的使用与生理学控制措施的改进之间的关联(H1a)，以及 对于有精神健康问题的患者和农村地区的患者(H1B)，这种联系将有所不同。 目标2.生成有关患者如何有效使用患者门户的详细信息。 我们将收集血糖(HbA1c)控制良好和控制不良的患者的数据 (控制)。使用调查和安全消息编码，我们将检查通信中的差异 与临床团队(信息共享、信息寻求、社会情感交流)，以及在 从他们的门户与家庭和/或非退伍军人管理局提供商共享信息。 目的3.使用随机激励设计进行小规模实验，以测试 让退伍军人参与支持性收养干预，以促进MHV的有效使用，样本为 200名患有糖尿病的退伍军人(有或不伴有心理健康问题) 对于目标3，我们将设计一种支持采用干预措施，利用与 目标1和目标2中的最大证据，寻求关键利益攸关方对干预的反馈(例如，初级保健 提供者、工作人员、患有糖尿病的退伍军人)，然后在贝德福德/波士顿VAMC随机选择患者 受邀参加干预活动。评估将重点放在增加使用MHV和 在未来的IIR中进行大规模实施精细化干预的可行性。 这项研究将开发和测试一种改善糖尿病护理的干预措施，同时加强证据 使用患者门户功能并寻求确保干预措施对农村有效的基础 退伍军人和那些有共同精神健康诊断的人。它将创建有关门户要素的新知识 这对管理其他复杂的慢性疾病应该是有用的。这项研究将在#年进行 与外地(VISN 1)和信息学和分析办公室的业务伙伴协作，以及 将通过这些合作伙伴传播。

Abstract Currently over 3 million Veterans have adopted the VA Patient Portal, My HealtheVet (MHV), however actual use of the portal varies considerably, and we have little data on how the portal features can best improve patient outcomes, or whether effective use varies by subgroups. We will work to define effective use, using clinical and administrative data, coding of secure messages, patient surveys, and in-depth interviews with extensive MHV experience. Lessons from this work will be used to refine an intervention to support effective use of MHV portal features for chronic disease management. We have chosen to anchor our research in a particular disease area: Type 2 diabetes, a complex disease affecting many Veterans associated with significant mental and physical comorbidities, complications and negative outcomes, and requiring high levels of self-management. Among a national sample of Veterans with uncontrolled diabetes, Aims 1 and 2 use a cohort-with-nested-case- control design to generate needed information to personalize interventions and to define effective use of the patient portal. Aim 3 is a small-scale experiment designed to test a MHV supported adoption intervention. Our Specific Aims are to: Aim 1. Generate new information for feature selection and personalizing interventions. In a national longitudinal cohort of Veterans with uncontrolled type 2 diabetes, we will test the association of patient portal tool use with improvements in physiologic measures of control (H1a), and the association will differ for patients with mental health conditions and those in rural areas (H1b). Aim 2. Generate details about how patients are effectively using the patient portal. We will collect data on patients with good glycemic (HbA1c) control (cases) and with poor control (controls). Using surveys and secure message coding, we will examine differences in communication with the clinical team (information sharing, information seeking, socio-emotional exchange), and in sharing information from their portals with family and/or non-VA providers. Aim 3. Conduct a small-scale experiment, using a randomized encouragement design, to test the feasibility of engaging Veterans in supported adoption intervention to promote effective MHV use, in a sample of 200 Veterans with diabetes (with or without comorbid mental health problems) For Aim 3, we will design a supported adoption intervention leveraging the features associated with the greatest evidence in Aims 1 and 2, seek feedback on the intervention from key stakeholders (e.g., primary care providers, staff, Veterans with diabetes), and then randomize patients at the Bedford/Boston VAMCs to be invited to participate in the intervention. Evaluation will focus on impact on increased use of MHV and feasibility of conducting a large scale implementation of the refined intervention in a future IIR. This research will develop and test an intervention to improve diabetes care, while strengthening the evidence base for using patient portal features and seeking to ensure that the intervention will be effective for rural Veterans and those with comorbid mental health diagnoses. It will create new knowledge about portal features that should be useful in managing other complex chronic conditions. This research will be conducted in collaboration with operational partners in the field (VISN 1) and in the Office of Informatics and Analytics, and will be disseminated through those partners.