Improving glaucoma self-management with technology-supported counselors

 描述（由申请人提供）：青光眼是美国不可逆性失明的主要原因。然而，至少有一半的青光眼患者没有服用被证明可以预防视力丧失的药物。目前的临床实践缺乏解决这一问题的战略框架。该提案的总体目标是提高依从性，同时最大限度地提高我们眼科医疗保健工作人员的效率。该项目旨在利用技术来支持医疗提供者团队提供高质量的个性化教育和咨询，否则只能通过与医生的长期对话来提供。该项目将使用运营工程（OE），其目标是优化复杂系统和流程的效率，以提供一个框架来提高诊所访问的效率，以便将个性化咨询和支持整合到标准护理中。OE 工具将被用来分析调度，工作流程和工作分配，以优化以团队为基础的眼科护理的应用，以改善对患者自我管理行为的支持。建议的咨询策略旨在通过允许相同水平的患者数量来维持患者对青光眼专科服务的访问。 这项工作将完善和试点测试eyeGuide，这是一个基于计算机的个性化行为改变计划，使医疗助理能够接受简短的培训，以激励和支持青光眼患者改善自我管理和药物依从性。PI和她的导师团队已经开发了一个eyeGuide的原型。在这个项目中，医疗助理接受基于动机访谈的方法培训，使用eyeGuide向每位患者提供个性化信息和指导。将根据当前临床实践的操作工程（OE）分析中收集的信息对eyeGuide进行改进。将使用OE价值流映射来确定何时在患者的诊所访视期间包括额外的教育和咨询。OE计算机建模技术将用于生成不同的理论模型，以测试如何将额外的咨询和教育最佳地整合到青光眼患者护理中。eyeGuide程序将根据这些分析进行改进，并在非粘连性青光眼患者中进行初步测试。将评估其对依从性的影响，真实的时间监测，以及依从性的社会心理调节剂。 Newman-Casey博士将成为一名独立的青光眼研究人员，拥有有效的健康沟通，运营工程和混合方法干预设计和分析方面的技能。随着美国人口老龄化和随之而来的眼科医生短缺，青光眼的患病率不断上升，因此设计、实施和评估基于系统的方法以改善以患者为中心的眼科护理模式至关重要。

 DESCRIPTION (provided by applicant): Glaucoma is a leading cause of irreversible blindness in the United States. Yet, at least one-half of glaucoma patients do not take the medications that are proven to prevent vision loss. Current clinical practice lacks a strategic framework to address this issue. The overarching objective of the proposal is to improve adherence while maximizing the efficiency of our ophthalmic healthcare workforce. The project aims to leverage technology to support medical provider teams to deliver high-quality individualized education and counseling that would otherwise be available only through an extended conversation with a physician. The project will use operations engineering (OE), a field whose goal is to optimize efficiency in complex systems and processes, to provide a framework to increase the efficiency of clinic visits in order to integrate individualized counseling and support into standard care. OE tools will be used to analyze scheduling, work- flow and work-allocations to optimize the application of team-based eye care to improve support for patient's self-management behaviors. The proposed counseling strategy will be designed to maintain patient access to glaucoma specialty services by allowing the same level of patient volume. This work will refine and pilot test the eyeGuide, a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence. The PI and her mentorship team have developed a prototype of the eyeGuide. In this program, medical assistants are trained in motivational interviewing-based approaches to use the eyeGuide to deliver individualized information and coaching to each patient. The eyeGuide will be refined based on information gathered in an operations engineering (OE) analysis of current clinical practice. OE value stream mapping will be used to identify when to include additional education and counseling during a patient's clinic visits. OE computer modeling techniques will be used to generate different theoretical models in which to test how to optimally integrate additional counseling and education into glaucoma patient care. The eyeGuide program will be refined based on these analyses and pilot tested with non-adherent glaucoma patients. Its effect on adherence, monitored in real time, and psychosocial mediators of adherence will be evaluated. The proposed training and research will prepare Dr. Newman-Casey to become an independent glaucoma researcher, with skills in effective health communication, operations engineering, and mixed methods intervention design and analysis. In light of the growing prevalence of glaucoma as the US population ages and concomitant projected shortages of ophthalmologists, the design, implementation and evaluation of systems-based approaches towards an improved model of patient centered eye care is critically important.