Expanding Patient Engagement in Diabetes Care: Patient Portal Innovation

扩大患者对糖尿病护理的参与：患者门户创新

• 批准号: 10443892
• 负责人: William Martinez
• 金额: $ 51.81万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 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/10443892
• 关键词: Address; Adopted; American; Attitude; Awareness; Blindness; Cardiovascular Diseases; Caring; Chronic; Clinical; Clinical Services; Data; Development; Diabetes Mellitus; Disease; Education; Electronic Health Record; Eye diseases; Feedback; Health Services; Health Services Accessibility; Health Status; Infrastructure; Intervention; Interview; Kidney Diseases; Medical Care Team; Methodology; Monitor; Notification; Ophthalmic examination and evaluation; Outcome; Patient Care; Patients; Physicians; Preventive Health Services; Preventive service; Primary Care Physician; Randomized Controlled Trials; Research; Schedule; Self Management; Services; Surveys; System; Technology; Testing; Time; Translational Research; Vaccines; Visit; Workload; colon cancer screening; cost; dashboard; design; diabetic; evidence base; evidence based guidelines; experience; health data; health information technology; health literacy; improved; innovation; literacy; novel; patient engagement; patient portal; prevent; public health relevance; service intervention; usability; user centered design

Project Summary/Abstract Evidence-based diabetes monitoring & preventative services can prevent or delay many costly and highly morbid disease-related complications, yet many patients do not receive all clinically-meaningful, evidence- based services. For example, while detecting and treating early diabetic eye disease can reduce the development of severe vision loss by an estimated 60%, approximately 40% of Americans with diabetes do not receive an annual eye exam. Prior research has demonstrated numerous barriers to the completion of evidence-based diabetes monitoring & preventative services including patient factors (eg, lack of awareness and limited health literacy) and clinician/system factors (eg, limited physician time and patient support between visits). Attempts to increase diabetes monitoring & preventative services have had only modest results. To achieve optimal rates of these services, an intervention is urgently needed that improves clinical efficiency by decreasing clinician workload, is appropriate for patients with varying levels of health literacy, and is highly scalable and sustainable. By providing an engaging and convenient means to track and visualize health data, obtain education and guidance, receive notifications, and connect patients and doctors, patient portals offer a promising platform to enhance access to health services while overcoming the limitations of costly and difficult to scale face-to-face interventions. Our research team previously applied user-centered Design Sprint methodology to develop patient portal features and functionality that were engaging and satisfying for a diverse group of patients with diabetes to use and provided users with a better understanding of their diabetes health data (eg, A1C). Feedback from users indicated a desire to self-order and self-schedule services when they become due. Using a similar approach and with strong institutional endorsement, we will design, usability test, and evaluate a novel patient portal intervention to: (a) notify patients when selected, clinically-meaningful, evidence-based diabetes monitoring & preventative services (eg, annual eye exam) become due and provide reminders for timely completion, (b) promote understanding of the importance of these services through literacy sensitive content, and (c) allow patients, when due by evidence-based guidelines, to ‘self-order’ (requires primary care physician (PCP) single-click co-signature) lab tests (eg, A1C) and vaccines prior to doctor’s visits and self-schedule clinical services (eg, eye exam). Specifically, we aim to: (1) apply Design Sprint methodology and usability testing to design and test a patient portal intervention (described above) that can overcome patient and clinician/system barriers to completing evidence-based, clinically meaningful, diabetes monitoring & preventative services among a diverse group of patients, (2) evaluate the effect of the patient portal intervention developed in Aim 1 on the completion of those services in a pragmatic, cluster randomized controlled trial, and (3) assess PCP’s attitudes and experiences, through surveys and interviews, regarding the acceptability and usefulness of the intervention and its impact on clinical efficiency.

项目摘要/摘要 以证据为基础的糖尿病监测和预防服务可以预防或延迟许多昂贵和高度 病态疾病相关并发症，但许多患者没有收到所有临床上有意义的证据- 基于服务的服务。例如，虽然检测和治疗早期糖尿病眼病可以减少 严重视力丧失的发生率估计为60%，约40%的美国糖尿病患者没有 接受一年一度的视力检查。先前的研究已经证明了完成以下任务的许多障碍 包括患者因素在内的循证糖尿病监测和预防服务(例如，缺乏意识 和有限的健康素养)和临床医生/系统因素(例如，有限的医生时间和患者支持 访问)。加强糖尿病监测和预防服务的努力收效甚微。至 要实现这些服务的最佳比率，迫切需要通过以下方式提高临床效率的干预措施 减少临床医生的工作量，适合具有不同健康素养水平的患者，并且高度 可扩展且可持续。通过提供用于跟踪和可视化健康数据的吸引人的和方便的手段， 获得教育和指导，接收通知，并连接患者和医生，患者门户网站提供 有希望的平台，以加强获得保健服务的机会，同时克服昂贵和困难的限制 扩大面对面干预的规模。我们的研究团队之前应用了以用户为中心的设计冲刺 开发患者门户特性和功能的方法，这些特性和功能对不同的 为糖尿病患者群体提供使用，并为用户提供更好的了解其糖尿病健康状况 数据(如A1C)。用户的反馈表明，他们希望在以下情况下自行订购和安排服务 成为到期的。使用类似的方法并得到机构的大力支持，我们将设计、可用性测试、 并评估一种新的患者门户干预措施以：(A)通知患者何时被选择、具有临床意义、 以证据为基础的糖尿病监测和预防服务(例如，年度眼科检查)成为当务之急并提供 提醒及时完成，(B)通过以下方式促进对这些服务重要性的认识 识字敏感内容；以及(C)根据循证指导原则，允许患者“自我点餐” (需要初级保健医生(PCP)点击共同签名)实验室检测(例如，A1C)和疫苗 医生就诊和自行安排临床服务(例如，眼科检查)。具体地说，我们的目标是：(1)应用设计 Sprint方法论和可用性测试以设计和测试患者门户干预(如上所述) 可以克服患者和临床医生/系统障碍，完成循证、临床有意义的、 在不同的患者群体中提供糖尿病监测和预防服务，(2)评估 在目标1中开发的患者门户干预是在务实的集群中完成这些服务的 (3)通过调查和访谈评估PCP的态度和经历， 关于干预措施的可接受性和有效性及其对临床效率的影响。