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: 9238106
• 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/9238106
• 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; Clinical Treatment; Comorbidity; Complex; Congestive Heart Failure; Consensus; Coronary Arteriosclerosis; Cost Sharing; Data; Diabetes Mellitus; Diagnosis; Diagnostic; 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; 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; 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; improved outcome; interest; mHealth; medical specialties; medication compliance; mobile application; novel; older patient; patient population; programs; socioeconomics; telehealth; time use; 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.

概括 这项更新研究将探讨面向患者的数字医疗技术的使用如何影响质量和 糖尿病患者的资源利用。使用 13 年的研究期（2007-2019），我们利用了交错的 实施移动应用程序、基于网络的健康计划和患者提供者视频访问 2008 年至 2014 年间，在超过 200,000 名糖尿病患者（现有或新发糖尿病患者）中， 诊断）。集成的传输系统设置可全面捕获诊断和 患者所有临床医生（初级保健医生）的治疗数据（包括药物、实验室结果和影像） 和专家）在住院和门诊环境中，并通过 门户移动应用程序。我们在最初的研究中取得了成功，该研究检验了面向临床医生的影响 电子健康记录（EHR），发现与改善糖尿病护理质量（增加 指南推荐的检测和治疗）和临床结果（改善血糖和血脂控制， 减少急诊室就诊和住院次数）。该更新提案将这一调查范围扩展到 包括面向患者的新颖技术。我们将检查的所有技术都与 患者持续的医疗保健提供者和更广泛的临床电子病历，与不断增长的健康人数形成鲜明对比 可供患者下载的应用程序是数据死胡同，导致护理更加分散。这 提出的主要研究预测因素是患者技术的使用（移动应用程序、基于网络的健康计划、 以及患者与提供者的视频访问）。在目标 1 中，我们将检查是否使用面向患者的技术 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 糖尿病和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） 治疗其他四种慢性合并症（哮喘、冠心病、慢性心力衰竭和高血压）中的任何一种。在目标 2 中，我们将检查 资源使用结果衡量指标，包括门诊就诊、急诊就诊和非选择性就诊 住院治疗。使用边际结构模型，我们将测试患者技术使用的假设 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， 最近健康状况、病例组合、亲自就诊的费用分摊以及患者人口统计和 社会经济特征。拟议的研究可能是对影响的最大的严格研究 面向患者的技术使用对健康结果的影响，包括患者提供者的视频访问远程医疗。经过 检查该技术的早期采用者以及具有复杂临床和自我诊断的糖尿病患者 管理需求，该项目有潜力提供及时的证据，为新兴的远程医疗和 移动医疗政策、技术采用决策以及临床医生和患者在现实世界中的使用。