Impact of Integrated Patient-Facing Health IT Tools on Quality and Resource Use for Patients with Diabetes

面向患者的集成健康 IT 工具对糖尿病患者的质量和资源使用的影响

• 批准号: 9353753
• 负责人: Mary Reed
• 金额: $ 58万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-06 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9353753
• 关键词: Accounting; Admission activity; Adoption; Affect; Affordable Care Act; Ambulatory Care; American; Asthma; Attention; Behavior; Blood Glucose; Blood Pressure; Body mass index; Caring; Case Mixes; Characteristics; Chronic; Clinical; Comorbidity; Complex; Congestive Heart Failure; Consensus; Coronary Arteriosclerosis; Cost Sharing; Data; Diabetes Mellitus; Diagnosis; Diagnostic; Drug Prescriptions; Drug usage; Electronic Health Record; Emergency department visit; Ethnic Origin; Event; Future; Glycosylated hemoglobin A; Guidelines; Health; Health Personnel; Health Services Accessibility; Health Status; Health Technology; Healthcare; Hospitalization; Hypertension; Image; Inpatients; Integrated Delivery Systems; Internet; Investments; LDL Cholesterol Lipoproteins; Laboratories; Link; Lipids; Low-Density Lipoproteins; Measures; Medical; Monitor; National Institute of Diabetes and Digestive and Kidney Diseases; Online Systems; Outcome; Outcome Measure; Outpatients; Patient Care; Patient-Focused Outcomes; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physiological; Play; Policies; Policy Developments; Population; Primary Health Care; Privatization; Probability; Provider; Quality of Care; Recording of previous events; Research; Resources; Role; Secure; Self Care; Self Management; Specialist; Structural Models; Subgroup; Technology; Telephone; Testing; Time; Visit; Weight; Wellness Program; base; blood lipid; demographics; digital; disorder control; health application; health care quality; health data; health information technology; improved; interest; low socioeconomic status; mHealth; medical specialties; medication compliance; mobile application; mobile computing; novel; older patient; patient population; programs; socioeconomics; telehealth; tool; treatment adherence

SUMMARY This renewal study will examine how use of patient-facing digital health technologies impacts quality and resource use for patients with diabetes. Using a 13 year study period (2007-2019), we exploit the staggered implementation of mobile applications, web-based wellness programs, and patient-provider video-visits between 2008-2014, among a large population of over 200,000 patients with diabetes (ongoing or new diagnoses). The integrated delivery system setting provides comprehensive capture of diagnostic and treatment data (including medications, lab results and imaging) across all of a patient’s clinicians (primary care and specialists) in inpatient and outpatient settings, and make integrated data available to patients through the portal mobile applications. We were successful in our original study examining the impact of clinician-facing electronic health records (EHRs), finding associations with improved diabetes care quality (increases in guideline-recommended testing and treatment), and clinical outcomes (improved blood sugar and lipid control, reductions in emergency room visits and hospitalizations). This renewal proposal extends this line of inquiry to include novel patient-facing technologies. All of the technologies we will examine are well-integrated with patients’ ongoing health care providers and broader clinical EHR, in contrast with the growing number of health applications available for patient download that are a data dead-end, leading to more fragmented care. The main proposed study predictor is patient technology use (mobile applications, web-based wellness programs, and patient-provider video-visits). In Aim 1, we will examine whether use of patient-facing technologies improves quality of care in patients with diabetes, specifically examining guideline-adherent prescription drug use and laboratory monitoring, drug adherence, and physiologic disease control (lab values) for diabetes and for any of four other comorbid chronic conditions (Asthma, CAD, CHF, and HTN). In Aim 2, we will examine resource use outcome measures including outpatient visits, emergency department visits, and non-elective hospitalizations. Using marginal structural models, we will test the hypotheses that patient technology use is associated with improved quality and lower in-person visit rates, while accounting for patient engagement, recent changes in health status, case-mix, cost-sharing for in-person visits, and patient demographic and socio-economic characteristics. The proposed study is likely to be the largest rigorous study of the impact of patient-facing technology use on health outcomes, including patient-provider video visit telehealth. By examining an early adopter of the technologies, and patients with diabetes who have complex clinical and self- management needs, this project has the potential to provide timely evidence to inform emerging telehealth and mhealth policies, technology adoption decisions, and real world use by clinicians and patients.

总结 这项更新研究将研究使用面向患者的数字医疗技术如何影响质量， 对糖尿病患者的资源利用。使用13年的研究期（2007-2019），我们利用交错的 实施移动的应用程序、基于Web的健康计划和患者-提供者视频访问 在2008-2014年期间，在超过20万糖尿病患者（正在进行或新发）中， 诊断）。集成的输送系统设置提供了诊断和 患者所有临床医生（初级保健）的治疗数据（包括药物、实验室结果和成像 和专家），并通过 门户移动的应用程序。我们在最初的研究中成功地检查了临床医生面对 电子健康记录（EHR），发现与改善糖尿病护理质量（增加 指南推荐的测试和治疗），和临床结果（改善的血糖和血脂控制， 减少急诊室就诊和住院）。这一更新建议将调查范围扩大到 包括新颖的面向患者的技术。我们将研究的所有技术都与 患者的持续医疗保健提供者和更广泛的临床EHR，与越来越多的健康 可供患者下载的应用程序是数据的死胡同，导致更分散的护理。的 主要建议的研究预测因素是患者技术使用（移动的应用程序，基于网络的健康计划， 和患者-提供者视频访问）。在目标1中，我们将研究使用面向患者的技术是否 提高糖尿病患者的护理质量，特别是检查符合指南的处方药 糖尿病的使用和实验室监测、药物依从性和生理疾病控制（实验室值）， 其他四种共病慢性疾病（哮喘、CAD、CHF和HTN）中的任何一种。在目标2中，我们将研究 资源使用结局指标，包括门诊访视、急诊科访视和非择期 住院治疗使用边际结构模型，我们将测试假设，病人的技术使用是 与提高质量和降低亲自就诊率相关，同时考虑到患者参与度， 健康状况、病例组合、亲自就诊的费用分摊以及患者人口统计学和 社会经济特征。这项拟议中的研究可能是最大的严格研究的影响， 在健康结果方面使用面向患者的技术，包括患者-提供者视频访问远程保健。通过 检查技术的早期采用者，以及具有复杂临床和自我- 管理需要，该项目有可能提供及时的证据，为新兴的远程保健提供信息， 移动医疗政策、技术采用决策以及临床医生和患者在真实的世界中的使用。