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: 9751267
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9751267
• 关键词: Accounting; 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 Management; 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 Status; Health Technology; Healthcare; Hospitalization; Hypertension; Image; Inpatients; Integrated Delivery Systems; Internet; Investments; LDL Cholesterol Lipoproteins; Laboratories; Link; Lipids; Low-Density Lipoproteins; Measures; Medical; Mobile Health Application; 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; Technology; Telephone; Testing; Time; Visit; Weight; Wellness Program; base; blood lipid; care coordination; digital; disorder control; health application; health care availability; health care quality; health data; health information technology; hospital readmission; improved; interest; low socioeconomic status; mHealth; medical specialties; medication compliance; mobile application; mobile computing; novel; older patient; patient engagement; patient population; patient subsets; programs; self-management program; sociodemographics; 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

项目成果

Association of Mobile Patient Portal Access With Diabetes Medication Adherence and Glycemic Levels Among Adults With Diabetes.

• DOI: 10.1001/jamanetworkopen.2019.21429
• 发表时间: 2020-02-05
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Graetz I;Huang J;Muelly ER;Fireman B;Hsu J;Reed ME
• 通讯作者: Reed ME

Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.

• DOI: 10.7326/0003-4819-157-7-201210020-00004
• 发表时间: 2012-10-02
• 期刊: Annals of internal medicine
• 影响因子: 39.2
• 作者: Reed M;Huang J;Graetz I;Brand R;Hsu J;Fireman B;Jaffe M
• 通讯作者: Jaffe M

Video Telehealth Access and Changes in HbA1c Among People With Diabetes.

• DOI: 10.1016/j.amepre.2021.10.012
• 发表时间: 2022-05
• 期刊: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
• 影响因子: 5.5
• 作者: Graetz, Ilana;Huang, Jie;Muelly, Emilie R.;Hsueh, Loretta;Gopalan, Anjali;Reed, Mary E.
• 通讯作者: Reed, Mary E.