A Direct-to-Patient Alert for Glycated Hemoglobin Screening Using Prediction Modeling and Mobile Health (mHealth)

使用预测模型和移动健康 (mHealth) 直接向患者发出糖化血红蛋白筛查警报

• 批准号: 9895588
• 负责人: Brian Jay Wells
• 金额: $ 14.29万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895588
• 关键词: Direct; Patient; Alert; Glycated; Hemoglobin

The purpose of this project is to develop a novel direct-to-patient alert using text messaging. The text messages will be targeted to patients found to be at a high risk for elevated blood sugar using a previously validated risk calculator that was created from routine data available in an electronic health record (EHR), which was found to be significantly more accurate than existing tools for identifying at risk patients. Text messages will be sent to high-risk individuals who have agreed to receive texts. The message will inform patients of their elevated risk for diabetes, invite patients to undergo a free diabetes screening test, and provide a link to a web page containing additional relevant information. Studies that improve the detection of patients with abnormal glucose are important because most patients diagnosed with Type 2 Diabetes already have evidence of end-organ damage by the time the disease is identified. Earlier diagnosis can lead to additional prevention strategies to detect and reduce associated morbidities by alerting the physician and patient to a previously unrecognized health status and facilitate shared decision making. The patients will be offered the opportunity to undergo a free diabetes-screening test (glycated hemoglobin) that does not require fasting, can be performed at the patients' convenience, and does not require an office visit. Patients with an elevated glycated hemoglobin (>5.7%) will be encouraged to follow-up with their physician. An additional component of the grant is a qualitative study that will perform focus groups with patients to create the most appealing texting intervention possible. Preliminary findings indicate a strong preference for texting over alternative modes of communication and identify favorable content components and phrasing. The inclusion of an informational web page was suggested by preliminary focus groups to enhance content and length of the message. The qualitative component is important as it explores ways to optimize direct patient engagement as a means to overcome the poor response of physicians to electronic reminders due to a phenomenon that has been termed, “alert fatigue.” The project is also novel in the use of text messaging, which has recently become both inexpensive and widely available across all ages, races and income groups for a direct-to patient intervention. Previous research indicates that universal screening for diabetes is not cost-effective, while targeted screening using crude patient groups is marginally cost-effective. Although this pilot grant will likely be too small to demonstrate definitive cost benefits of targeted diabetes screening using a risk calculator, it will set the stage for a larger randomized trial in the future. This pilot and a future trial can also contribute to the wider assessment of the viability of texting as a tool for preventative medicine in general and serve as evidence to support greater routine use of interventions involving accessible and cost-effective health information technology methods that are currently underutilized by demonstrating successful flow from application of the calculator to EHR data to text to laboratory results. The authors strongly believe in patient empowerment and hope that this project will encourage more studies to leverage direct patient interventions based on personalized recommendations to promote self-efficacy and equity within the health care system.

这个项目的目的是开发一种新的使用短信直接发送给患者的警报。短信将会是 使用先前验证的风险计算器针对被发现有高血糖风险的患者 是从电子健康记录(EHR)中可用的常规数据创建的，这被发现明显更多 比现有的识别高危患者的工具更准确。短信将发送给符合以下条件的高危个人 同意接收短信。该信息将告知患者他们患糖尿病的风险增加，邀请患者接受 免费的糖尿病筛查测试，并提供包含其他相关信息的网页链接。研究表明 改善对血糖异常患者的检测很重要，因为大多数被诊断为2型的患者 当疾病被发现时，糖尿病已经有了终末器官损害的证据。早期诊断可能导致 其他预防策略，通过提醒医生和患者注意 以前未被认识到的健康状况，并促进共同决策。患者将有机会 要接受免费的糖尿病筛查测试(糖化血红蛋白)，不需要禁食，可以在 方便患者就诊，不需要到办公室就诊。糖化血红蛋白升高(&gt；5.7%)的患者将 鼓励他们向他们的医生进行随访。赠款的另一个组成部分是定性研究，它将 与患者一起进行焦点小组，尽可能地进行最具吸引力的短信干预。初步调查结果 表明对短信的强烈偏好，而不是其他沟通方式，并确定有利的内容 组件和短语。初步焦点小组建议列入一个信息网页，以 增加信息的内容和长度。定性部分很重要，因为它探索了优化的方法 直接患者参与作为一种手段，以克服医生对电子提醒的不良反应，因为 这种现象被称为“警觉疲劳”。该项目在短信的使用上也是新颖的，这使得 最近变得既便宜又广泛适用于所有年龄段、种族和收入群体的直达患者 干预。先前的研究表明，全面筛查糖尿病并不划算，尽管是有针对性的 使用原始患者组进行筛查略微具有成本效益。尽管这笔试点拨款可能太少，无法 展示使用风险计算器进行目标糖尿病筛查的最终成本效益，它将为 在未来进行更大规模的随机试验。这一试点和未来的试验也有助于更广泛地评估 短信作为预防医学工具的可行性，并作为支持更多常规使用的证据 涉及可获得和具有成本效益的卫生信息技术方法的干预措施，目前 通过演示从应用计算器到电子病历数据再到文本到实验室的成功流程，未得到充分利用 结果。作者强烈支持患者赋权，并希望该项目将鼓励更多的研究 利用基于个性化建议的直接患者干预来提高自我效能和公平性 在医疗保健系统内。