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A multi-level intervention to increase access and use of patient portals for diabetes management in community health centers (MAP)

多层次干预措施，以增加社区卫生中心 (MAP) 糖尿病管理患者门户的访问和使用

基本信息

批准号：
10649414
负责人：
JULIE A WAGNER
金额：
$ 20.86万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-17 至 2024-09-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10649414
关键词：
Address Adoption Adult Appointment Behavior Behavioral Biological Factors Black race Blood Glucose Caring Clinic Communication Communities Community Health Aides Comprehensive Health Care Data Decision Making Diabetes Mellitus Disparity Education Educational Materials Elderly Emergency department visit Ethnic Origin Focus Groups Fostering General Population Health Health Personnel Health Resources Healthcare Healthcare Systems Healthy Eating Hospitalization Internet Intervention Interview Knowledge Latinx Measures Medical Care Team Medical Records Methods Modeling Morbidity - disease rate Neighborhood Health Center Non-Insulin-Dependent Diabetes Mellitus Nurses Office Visits Outcome Participant Patient-Centered Care Patients Pharmaceutical Preparations Physical activity Play Population Prevalence Preventive screening Protocols documentation Provider Psychosocial Factor Public Health Qualitative Methods Research Personnel Resources Role Secure Self Efficacy Services Socioeconomic Status Tablets Testing Training Vulnerable Populations World Health Organization clinical care cost design diabetes distress diabetes management diabetes self-management disparity reduction eHealth ethnic minority population experience glucose monitor glycemic control health care availability health care disparity health disparity health equity health inequalities improved intervention delivery literacy low health literacy low socioeconomic status mathematical ability mortality novel outreach participant interview patient engagement patient portal primary outcome provider communication psychosocial racial diversity racial minority population secondary outcome social health determinants socioeconomics systematic review technology training therapy design underserved community web site

项目摘要

Abstract In the US, there are significant health care disparities in the prevalence, morbidity, and mortality of type 2 diabetes (T2D) in racial and ethnic minority populations. Increased patient portal use, such as accessing medical records and secure messaging with providers has the potential to improve engagement with care and diabetes health outcomes. Yet, there are substantial disparities in portal use by adults who are of diverse race/ethnicity and with limited socioeconomic resources. Over 1,400 community health centers (CHCs) in the US provide comprehensive health care to adults of diverse races and ethnicities in underserved communities and play a critical role in addressing health inequities in T2D care. We propose to develop a multi-level intervention to increase access and use of patient portals for diabetes management (MAP) in community health centers (CHC) aligned with the World Health Organization (WHO) Social Determinants of Health Equity framework. The intervention will: 1) provide free access to tablets and internet (material circumstances); 2) technology training and ongoing support (psychosocial factors); 3) assess social determinants of health and refer to community resources (material circumstances); and, 4) support diabetes self-management behaviors and refer to clinic services (behavioral and biological factors). MAP will be delivered by community health workers (CHW) and nurses already embedded in CHCs (healthcare system). The study aims are to: 1) Optimize components of the MAP intervention for adults with T2D who access healthcare at CHCs by conducting focus groups/interviews with adults with T2D and health care providers (n=24) from two CHCs using established qualitative methods; and 2) determine the effect size of MAP use for adults with T2D at two CHCs (n=36) on the primary outcomes of portal use and A1C and secondary outcomes of: a) patient engagement with care, T2D self-management, and psychosocial outcomes. Using a within subjects, pre-post design we will pilot MAP in adults with T2D who are portal naive. We will use generalized linear mixed model (GLMM), incorporating correlations among repeated measures (baseline, 3 months, and 6 months) to analyze data. We will evaluate portal use factors associated with improvement in outcomes. We will rigorously evaluate the feasibility of MAP (acceptability, demand, implementation, adaptation, and integration) using an established framework and mixed methods. Lastly, we will explore the use of publicly available diabetes and health resources on the internet by adults with T2D when provided access to a tablet and internet. Results of this study will have important implications on the potential of a novel multi-level intervention provided in CHCs to improve patient portal use, diabetes self-management, and glycemic control in adults of diverse race/ethnicity with limited socioeconomic resources.

摘要