Leveraging mobile health technology to reduce avoidable healthcare utilization in persons with Alzheimer's Disease and Related Dementias in adult day centers

利用移动医疗技术减少成人日间中心阿尔茨海默病和相关痴呆症患者本可避免的医疗保健利用率

• 批准号: 10649808
• 负责人: Tina Sadarangani
• 金额: $ 5.18万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649808
• 关键词: Access to Information; Acute; Address; Adult; Alzheimer' s disease related dementia; Area; Behavior Therapy; Caregivers; Caring; Clinical; Communication; Communities; Dementia; Development; Distress; Early Diagnosis; Emergency Situation; Emergency department visit; Family; Future; Goals; Health; Health Status; Health Technology; Health system; Hospital Costs; Hospitalization; Integrated Health Care Systems; Intervention; Low income; Medical Records; Medical emergency; Mentored Patient-Oriented Research Career Development Award; Mentorship; Minor; Mobile Health Application; Notification; Outcome; Patients; Persons; Principal Investigator; Provider; Quality of Care; Registered nurse; Reporting; Research; Scientist; Services; Social Workers; Statutes and Laws; Symptoms; Testing; Time; Training; Treatment Efficacy; Visit; Visual; Work; acceptability and feasibility; behavior test; care providers; community based care; cost; design; disparity reduction; efficacy testing; experience; facsimile; health care delivery; health care service utilization; health care settings; health information technology; improved; informal caregiver; innovation; mHealth; programs; racial diversity; smartphone Application; user centered design

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoidable emergency de- partment (ED) visits and hospitalizations. Adult day service centers (ADCs) provide community-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily assessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to com- municate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve com- munication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an independent scientist who leads a re- search program that integrates care from ADCs and PCPs using mHealth interventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to address health care utilization disparities, developing mHealth interventions using user-centered design principles, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) Identify patient and caregiver reported warning signs that can be integrated into an mhealth application in order to address emerging clinical problems and distressing symptoms among PLWD in ADCs; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and informal care- givers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth application use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6- month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve stand- ards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access infor- mation from their medical records using their preferred smartphone application. This study is innovative be- cause it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the development of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.

项目摘要。 社区居住的痴呆症患者（PLWD）非常容易发生可避免的紧急情况， 定期（艾德）访视和住院。成人日间服务中心（ADCs）提供基于社区的护理， 不同种族的艾滋病毒/艾滋病感染者人数不断增加，其中大多数是低收入者。每日评估和系列 由ADC的跨学科工作人员（包括注册护士，社会工作者和计划 支持早期发现PLWD的临床问题。然而，当健康状况发生急剧变化时， 发生，ADC工作人员谁希望提供及时通知基层医疗服务提供者（PCP）往往不能做 如此有效。在我之前的研究中，我发现ADC工作人员依赖传真或语音邮件消息来通信- 传达紧急信息这导致PCP延迟或不响应，并允许轻微的健康问题。 问题升级为医疗紧急情况。随着ADC中PLWD数量的增长， 加强ADC、PCP和护理人员之间重要临床信息的沟通，以减少 昂贵的住院和艾德就诊。移动的健康（mHealth）干预措施已被证明可以改善com. 在各种医疗保健环境中进行通信和临床信息交换，但它们还没有被 专为ADC设计。我寻求K23奖的目标是成为一名独立的科学家，领导一项研究， 搜索计划，使用mHealth干预措施整合ADC和PCP的护理，以减少可避免的 艾滋病毒/艾滋病感染者利用保健的差异。在经验丰富的跨学科导师的支持下， 团队，我将获得三个方面的培训：使用综合卫生系统来解决卫生保健利用问题 差异，使用以用户为中心的设计原则开发mHealth干预措施，并设计和测试 行为干预。通过必要的培训，我将执行以下具体目标：（1）识别患者 和护理人员报告的警告信号，可以集成到mhealth应用程序中，以解决 ADCs中PLWD中出现的临床问题和令人痛苦的症状;（2）设计和测试视觉 mHealth应用程序的布局，旨在支持ADC、PCP和非正式护理之间的通信- （3）开发和研究移动医疗应用的可行性和可接受性 在ADC工作人员、PCP和非正式护理人员中，减少PLWD的住院和艾德就诊超过6- 月期间。我的研究结果将为未来的R 01提案提供信息，以测试使用全面干预的有效性。 移动健康应用这项研究意义重大，因为研究结果将用于改善林分- 提高护理水平并减少PLWD的昂贵和创伤性后果。它还推动立法， 国家卫生信息技术协调员要求患者能够访问信息， 使用他们喜欢的智能手机应用程序从他们的医疗记录中获取信息。本研究具有创新性， 因为它利用ADC的优势，并结合一线提供商的观点，为开发提供信息 一个务实的以用户为中心的移动健康应用程序，以整合护理和减少PLWD的差距。