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Amplifying provider impact on patient engagement with an EHR- integrated digital diabetes prevention program

通过 EHR 集成数字糖尿病预防计划，扩大医疗服务提供者对患者参与度的影响

基本信息

批准号：
10217118
负责人：
Devin M Mann
金额：
$ 65.47万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10217118
关键词：
Adoption Adult Body Weight Changes Body Weight decreased Caring Centers for Disease Control and Prevention (U.S.)Certification Clinical Clinical Data Cluster randomized trial Communication Complex Data Data Element Data Reporting Data Sources Diabetes Mellitus Diabetes prevention Effectiveness Electronic Health Record Enrollment Environment Epidemic Feedback Glycosylated hemoglobin A Goals Health Personnel Health behavior Health behavior change Healthcare Healthcare Systems Intervention Life Style Link Measurable Medical Care Team Methods Modeling Modernization Notification Outcome Pathway interactions Patient Monitoring Patients Perception Phase Physical activity Prediabetes syndrome Prevention program Primary Health Care Process Provider Randomized Role System Technology Testing Time Visualization Visualization software Weight Work base behavior change behavioral outcome cost data tools data visualization design diabetes prevention program digital digital health digital healthcare digital intervention disorder prevention evidence base experience health application health data implementation facilitators implementation outcomes implementation process implementation tool improved mobile computing multidisciplinary new technology novel patient engagement patient portal patient safety patient-clinician communication personalized care prevent primary care setting programs recruit satisfaction success theories tool trial comparing usability user centered design

项目摘要

Digital versions of diabetes prevention programs (dDPPs) offer an exciting opportunity to bring evidence-based DPPs to scale across the nation. dDPPs have been validated, CDC-recognized, commercialized, modernized on ubiquitous mobile platforms and are increasingly reimbursable. Automated sharing of dDPP patient- generated health data with the primary care team is now possible. However, no empiric data are available to guide the meaningful integration of this new data source within electronic health records (EHRs) or clinical workflows to support patient engagement in the dDPP. Healthcare providers need concise, actionable data to replace the large amounts of clinical data presented in the EHR that is increasingly scattered, conflicted, and poorly filtered, threatening patient safety and provider satisfaction. Our team, which built the first dDPP used in primary care, recently developed and tested a novel system that links this digital behavior change program with an EHR to create an enhanced visualization tool. This tool pushes meaningful visualizations of key dDPP data elements (e.g. weight, activity, lesson completion) directly into the complex EHR workflows of primary care to enhance patient engagement. Based on this prior work, we now seek to determine the impact of implementing our enhanced visualization tool in combination with other widely available EHR messaging and notification functionality (dDPP-EHR tool suite) for diabetes prevention in real-world primary care practice. To achieve this goal we propose 3 aims: 1) to adapt our suite of digital patient monitoring and engagement tools that will integrate patient dDPP data into the EHR workflow; 2) to conduct a pragmatic, clustered RCT in 40 primary care practices to observe the suite’s impact on patient engagement, weight loss, physical activity, and HbA1C among prediabetic patients enrolled in the dDPP; and 3) to evaluate the implementation process guided by the Technology Acceptance Model (TAM3) and Proctor’s Implementation Outcomes Framework. The dDPP-EHR tool suite adaptation phase is guided by a user-centered design process consisting of group feedback sessions, workflow analyses and agile design to refine the suite’s integration into existing clinical workflows. The suite of tools and optimized workflows will be linked to the dDPP from a collaborating commercial dDPP provider (Noom, Inc). Each primary care practice will then be randomly assigned to have (or not have) access to the tool while patients (10 per practice) are recruited via patient portal to receive a dDPP prescription from their provider. The main outcomes will be weight loss, physical activity, HbA1C and dDPP engagement over the 1-year intervention. Aim 3 will use a theory driven implementation assessment framework to assess the acceptability, adoption, cost, and sustainability of implementing the dDPP-EHR tool. We have assembled an experienced, multi-disciplinary team that includes a leading commercial digital diabetes prevention program provider to determine if connecting patients and providers through our novel dDPP-EHR tool suite has a measurable impact on diabetes prevention-related outcomes.

糖尿病预防计划(DDPP)的数字版本提供了一个令人兴奋的机会，将基于证据的 DPP将在全国范围内推广。DDPP已经过验证、疾控中心认可、商业化、现代化在无处不在的移动平台上，越来越多的人可以报销。DDPP患者的自动共享- 现在可以与初级保健团队一起生成健康数据。然而，没有经验数据可用来指导这一新数据源在电子健康记录(EHR)或临床中的有效集成支持患者参与DDPP的工作流程。医疗保健提供者需要简明、可操作的数据来取代电子病历中呈现的日益分散、相互冲突的大量临床数据过滤不佳，威胁到患者的安全和提供者的满意度。我们的团队，他们构建了第一个用于初级保健，最近开发和测试了一种新的系统，将这种数字行为改变计划与用于创建增强的可视化工具的EHR。此工具可推动关键DDPP数据的有意义的可视化要素(如体重、活动、课程完成率)直接纳入初级保健的复杂电子病历工作流中提高患者的参与度。在先前工作的基础上，我们现在寻求确定实施我们增强的可视化工具与其他广泛提供的电子病历消息和通知相结合在现实世界初级保健实践中用于糖尿病预防的功能性(DDPP-EHR工具套件)。要做到这一点目标我们提出3个目标：1)调整我们的数字患者监控和参与工具套件，将患者DDPP数据集成到EHR工作流程中；2)在40名初级医生中进行务实的集群式随机对照试验护理实践，以观察该套件对患者参与度、体重减轻、体力活动和糖化血红蛋白的影响在参加DDPP的糖尿病前期患者中；以及3)评估由技术接受模型(TAM3)和普罗科特的实施成果框架。DDPP-EHR 工具套件适配阶段由以用户为中心的设计过程指导，该过程由小组反馈组成会议、工作流分析和敏捷设计，以完善该套件与现有临床工作流的集成。该套工具和优化的工作流将从协作的商业DDPP链接到DDPP 供应商(Noom，Inc.)。然后，每个初级保健诊所将被随机分配到有(或没有)访问权限到该工具，同时通过患者门户招募患者(每个诊所10名)，以从其接收DDPP处方他们的提供者。主要结果将是体重减轻、体力活动、糖化血红蛋白和DDPP参与度超过为期一年的干预。目标3将使用理论驱动的实施评估框架来评估实施DDPP-EHR工具的可接受性、采用率、成本和可持续性。我们已经组装了一个经验丰富的多学科团队，包括领先的商业数字糖尿病预防计划提供商确定通过我们新的DDPP-EHR工具套件连接患者和提供商是否具有对糖尿病预防相关结果的可衡量影响。