A Theory-Based Patient Portal eLearning Program for Older Adults with Chronic Illnesses

项目摘要/摘要 慢性病的高患病率在美国是一个严重的公共卫生问题，超过70%的人 数以百万计的≥50岁成年人至少患有一种慢性病。慢性病的管理需要长期的 使用复杂的治疗计划并可能导致意想不到的后果，如增加 用药失误。患者门户(PPS)是联邦支持的医疗信息技术(IT)，可以 对慢性病患者特别有帮助。患者现在可以访问他们自己的健康记录和 通过PPS与护理人员直接沟通。先前的研究结果表明，使用PPS具有巨大的潜力 提高护理质量，联邦政府资助医疗保健组织实施这一工具 全国范围内(有意义的使用奖励支付计划)。尽管有潜在的好处，但总体PP 美国的领养率很低(2014年的一项全国调查为26.8%)。老年人中缺乏PP使用已经 已经被作为一个特别令人关切的问题来处理。然而，当只考虑使用互联网的老年人时， 他们使用PP的比例与其他年龄段相似。一些研究还报告说，老年人 总体而言，老年人需要额外的支持来学习使用PPS进行护理 管理，因为他们往往不太熟悉技术。目前，大多数老年人得到的钱很少或根本没有 他们的供应商提供PP支持。这是国家卫生信息技术计划中的一个重要差距，因为如果没有 适当的支持，老年人将无法使用这一强大的健康工具，错过了一个重要的机会 以改善他们的健康状况。为了填补这个空白，在我们的初步研究中，我们开发并测试了 一个基于老年人友好理论的患者门户电子学习计划(T-PEP)，以支持老年人使用 为他们的护理提供PPS。在拟议的可行性研究中，我们计划(目标1)优化和实施一家供应商- 不可知的T-PEP并进行形成性和过程评估(例如，可用性、促进器/障碍)；以及(目标2) 评估T-PEP对PP使用和选定结果的初步影响(PP知识、PP自我效能感 使用和健康决策、健康交流和药物调节)。双臂RCT将是 对患有慢性病(N=242，年龄≥50)的老年人进行调查，并在网上招募。数据将 在基线、治疗结束(3周)和4个月时收集。适当的分析方法将 针对每个研究目标，包括描述性统计、线性混合模型和定性分析。如果 如果这项研究成功，可能会直接影响为老年人提供的护理质量和 国家卫生信息技术倡议。这项研究的结果还将为医院、供应商和决策者提供 深入了解老年人当前的PP使用模式以及在使用各种类型的PP时的其他挑战 在国家一级的PPS，有助于推动PP技术的进步和实践的变化。在 在R01研究的下一阶段，我们将测试其对健康行为和临床结果的长期影响(例如， 改进HbA1c)使用更多样化的样本，包括实践环境和服务不足的人群。

Project Summary/Abstract The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million adults age ≥50 have at least one chronic illness. Management of chronic conditions requires long-term use of complex treatment plans and can cause unintended consequences, such as increased risk of medication errors. Patient portals (PPs), a federally supported health information technology (IT), can be especially helpful for patients with chronic illnesses. Patients can now access their own health records and directly communicate with care providers through PPs. Prior findings suggest a great potential for using PPs to improve care quality, and the federal government funds healthcare organizations to implement this tool nationwide (Meaningful Use incentive payment program). Despite the potential benefits, the overall PP adoption rate in the U.S. is low (26.8% in a 2014 national survey). A lack of PP use among older adults has been addressed as a particular concern. When only older adults who use the Internet are considered, however, their proportion of PP use is similar to other age groups. A few studies also reported that older adults are receptive to PPs.In general, older adults need additional support for learning to use PPs for their care management, as they tend to be less familiar with technology. Currently, most older adults receive little or no PP support from their providers. This is an important gap in the nation’s health IT initiative because without appropriate support, older adults will not be able to use this robust health tool, missing an important opportunity to improve their health outcomes. In an effort to fill this gap, in our preliminary study, we developed and tested an older adult friendly Theory-based Patient portal eLearning Program (T-PeP) to support older adults in using PPs for their care. In the proposed feasibility study, we plan to (Aim 1) optimize and implement a vendor- agnostic T-PeP and conduct formative and process evaluations (e.g., usability, facilitators/barriers); and (Aim 2) assess the preliminary impact of T-PeP on PP use and selected outcomes (PP knowledge, self-efficacy for PP use and health decision making, health communication, and medication reconciliation). A two-arm RCT will be conducted with older adults who have chronic conditions (N=242, age ≥50) and are recruited online. Data will be collected at baseline, the end of treatment (3 wks), and 4 months. Appropriate analytic approaches will address each study aim, including descriptive statistics, linear mixed models, and qualitative analyses. If successful, this study could directly affect quality of care provided to older adults and the success of the national health IT initiative. Findings from this study will also provide hospitals, vendors, and policymakers with in-depth information on older adults’current PP usage patterns and other challenges in using various types of PPs at the national level, contributing to the advancement of PP technology and changes in practice. In the next phase of the R01 study, we will test its long-term effects on health behaviors and clinical outcomes (e.g., improvement HbA1c) using more diverse samples, including practice settings and underserved populations.