mHealth for Heart Failure Symptom Monitoring

用于心力衰竭症状监测的移动健康

• 批准号: 9272953
• 负责人: Ruth Marie Masterson Creber
• 金额: $ 9.08万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9272953
• 关键词: Activities of Daily Living; Address; Adult; Award; Awareness; Cardiac; Cardiovascular system; Caring; Cellular Phone; Cessation of life; Chronic Disease; Clinical; Clinical Trials Design; Communication; Communities; Competence; Data; Development; Elderly; Elements; Emergency department visit; Engineering; Factor Analysis; Feasibility Studies; Fellowship; Fostering; Foundations; Funding; Goals; Growth; Health; Health Personnel; Healthcare; Heart failure; Hospitalization; Hospitals; Imagery; Impaired cognition; Information Systems; International; Intervention; Knowledge; Latino; Lead; Link; Measurement; Mentorship; Methodology; Mission; Modeling; Monitor; Motivation; National Institute of Nursing Research; Neighborhoods; New York City; Outcome; Outcomes Research; Participant; Pathway interactions; Patient Outcomes Assessments; Patient Preferences; Patient-Focused Outcomes; Patients; Pattern; Phase; Positioning Attribute; Postdoctoral Fellow; Presbyterian Church; Provider; Psychometrics; Public Health; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; Sample Size; Schools; Science; Scientist; Self Care; Self Management; Symptoms; Syndrome; Technology; Testing; Theoretical model; Time; Training; Underserved Population; United States National Institutes of Health; Universities; User-Computer Interface; Validity and Reliability; Washington; Work; base; behavioral health; behavioral health intervention; behavioral response; biomedical informatics; career; comparative efficacy; computer science; computerized; design; dynamic system; empowered; ethnic diversity; experience; health application; health disparity; health literacy; hedonic; high risk; hospital readmission; improved; improved outcome; innovation; insight; low socioeconomic status; mHealth; motivational enhancement therapy; novel; patient oriented; patient population; physical symptom; point of care; pre-doctoral; programs; psychologic; psychological symptom; public health relevance; racial diversity; response; satisfaction; skills; socioeconomics; symptom management; symptom science; symptomatic improvement; theories; treatment as usual; usability; user centered design; web app

 DESCRIPTION (provided by applicant): There is a fundamental gap in understanding better ways to engage patients with heart failure (HF) in symptom recognition, response, and communication with healthcare providers. Symptoms are the main driver of health- related outcomes for patients with HF and the primary driver of repeated hospital readmissions. Given that we are located in the Washington Heights neighborhood of New York City, a predominantly poor Latino community, we are uniquely positioned to address the health disparity in clinical outcomes for Latino patients with HF as well as others with HF using a mobile health (mHealth) application (app). The proposed long-term goal of this NIH K99/R00 application is to assist the candidate, Dr. Masterson Creber, in becoming an independent investigator with a program of research focusing on high quality, technology-based behavioral health interventions to improve outcomes and support patient-centered cardiovascular care for underserved patients with HF. The overall objective of the proposed project is to test the hypothesis that a novel app, mi.Symptoms can meaningfully alter patient-reported and clinical outcomes of patients with HF and lead to more successful symptom recognition, response and communication with healthcare providers. The central hypothesis is that empowering patients to take more control of their symptom experience using a technology-enabled point-of-care symptom reporting intervention (mi.Symptoms) can meaningfully alter symptom response behaviors the clinical outcomes of patients with HF. Guided by strong preliminary data, this hypothesis will be tested in the K99 phase of the study by pursing the following specific aims: 1) test the reliability and validity of mi.Symptoms (a novel mHealth app developed by Dr. Masterson Creber and a team from Columbia University School of Engineering), and 2) assess the usability of mi.Symptoms and examine relationships of its use with changes in patient-reported outcomes in a pilot feasibility study. In the R00 phase of the study, the specific aim is to: 3) examine the efficacy o mi.Symptoms on improving patient-reported and clinical outcomes as compared to usual care. The training plan for this K99/R00 Pathway to Independence Award will enable Dr. Masterson Creber to couple skills in biomedical informatics with clinical trial design and outcomes research. The approach has three innovative features: 1) it is grounded in the Theory of Situation Awareness in Dynamic Systems; 2) there is a close link between the theoretical model and unique functional elements of the mi.Symptoms web app (tailoring to patient preference by choosing an avatar, prompting to report symptoms, reinforcing symptom reporting with hedonic motivation, and decreasing barriers to facilitate communication with providers); and 3) it applies growth modeling to the analysis of multiple symptoms and outcomes over time. Findings from this study will provide insights into the development and testing of mi.Symptoms as well as many other mHealth apps. The research is significant because it addresses the important problem of patients with HF struggling to recognize and respond to their symptoms, and it addresses the health disparity in HF outcomes for Latino patients. To accomplish the aims of this proposed study, a robust mentorship team with internationally and nationally recognized experts has been built, including expertise in biomedical informatics with a focus on mHealth (Dr. Suzanne Bakken), cardiovascular behavioral health and clinical trial design (Dr. Karina Davidson), user-centered design (Dr. Steven Feiner), clinical heart failure management (Dr. Mathew Maurer), symptom monitoring (Dr. Kathleen Hickey), quantitative methodologies (Dr. Christopher Lee), and mHealth application development and testing (Dr. Cornelia Ruland). Since a spectrum of new knowledge and skills regarding biomedical informatics, computer science and user-interfaces, and behavioral health clinical trial design are required for the candidate's career as an independent scientist, this K99/R00 award will be extremely important and necessary to achieve the candidate's career objectives and expand symptom science and the science of self- management for vulnerable patients with chronic diseases.

 描述（由申请人提供）：在理解更好地让心力衰竭（HF）患者参与症状识别、反应和与医疗保健提供者沟通的方法方面存在根本性差距。症状是HF患者健康相关结局的主要驱动因素，也是反复入院的主要驱动因素。鉴于我们位于纽约市的华盛顿高地附近，这是一个以拉丁裔为主的贫困社区，我们具有独特的优势，可以使用移动的健康（mHealth）应用程序（app）解决拉丁裔HF患者以及其他HF患者临床结局的健康差异。这项NIH K99/R 00申请的拟议长期目标是帮助候选人Masterson Creber博士成为一名独立研究者，其研究项目专注于高质量，基于技术的行为健康干预措施，以改善结果并支持以患者为中心的心血管护理，为服务不足的HF患者提供服务。拟议项目的总体目标是测试一种新的应用程序的假设，mi.症状可以有意义地改变患者报告的HF患者的临床结果，并导致更成功的症状识别，反应和与医疗保健提供者的沟通。中心假设是，通过技术支持的床旁症状报告干预（mi.Symptoms），使患者能够更多地控制其症状体验，可以有意义地改变HF患者的症状反应行为和临床结局。在强有力的初步数据的指导下，将在研究的K99阶段通过追求以下具体目标来检验该假设：1）测试mi的信度和效度。症状（一款由Masterson Creber博士和来自哥伦比亚大学工程学院的团队开发的新型mHealth应用程序），和2）评估mi的可用性。症状并在试点可行性研究中检查其使用与患者报告结果变化的关系。在研究的R 00阶段，具体目的是：3）检查与常规护理相比，MI症状在改善患者报告和临床结局方面的疗效。K99/R 00独立之路奖的培训计划将使Masterson Creber博士能够将生物医学信息学的技能与临床试验设计和结果研究结合起来。 该方法具有三个创新特征：1）它以动态系统中的态势感知理论为基础; 2）理论模型与MI的独特功能元素之间存在密切联系。症状Web应用程序（通过选择化身、提示报告症状、以享乐动机加强症状报告以及减少促进与提供者沟通的障碍来定制患者偏好）;以及3）它将生长建模应用于随着时间的推移的多种症状和结果的分析。这项研究的结果将为mi的开发和测试提供见解。症状以及许多其他mHealth应用程序。这项研究意义重大，因为它解决了HF患者难以识别和应对其症状的重要问题，并解决了拉丁美洲患者HF结局的健康差异。为了实现这项拟议研究的目标，已经建立了一个由国际和国内公认的专家组成的强大的导师团队，包括以移动健康为重点的生物医学信息学专业知识（Suzanne Bakken博士），心血管行为健康和临床试验设计（Karina Davidson博士），以用户为中心的设计（Steven Feiner博士），临床心力衰竭管理（Mathew Maurer博士），症状监测（Kathleen Hickey博士）、定量方法学（Christopher Lee博士）和移动健康应用程序开发和测试（科尔内利亚Ruland博士）。由于候选人作为独立科学家的职业生涯需要一系列关于生物医学信息学，计算机科学和用户界面以及行为健康临床试验设计的新知识和技能，因此K99/R 00奖对于实现候选人的职业目标和扩展症状科学和慢性病弱势患者自我管理科学非常重要和必要。