Examining Psychosocial Factors of Chronic Disease Control to Improve Outcomes for Patients with Multiple Chronic Conditions

检查慢性病控制的心理社会因素以改善多种慢性病患者的治疗结果

• 批准号: 10535530
• 负责人: Kristen O'Loughlin
• 金额: $ 4.57万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-25 至 2023-08-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10535530
• 关键词: Address; Adult; American; Anxiety; Area; Award; Behavior; Biological; Caring; Characteristics; Chronic Care; Chronic Disease; Control Locus; Data; Data Analyses; Data Reporting; Data Sources; Development; Disease Management; Disease Outcome; Educational workshop; Effectiveness; Electronic Health Record; Equation; Female; Food; Foundations; Goals; Health; Health Care Costs; Healthcare Systems; Housing; Individual; Interdisciplinary Study; Intervention; Interview; Lead; Learning; Link; Literature; Longitudinal Studies; Medical Care Team; Mental Health; Mentorship; Methodology; Modeling; Mood Disorders; National Institute of Mental Health; Outcome; Pathway interactions; Patient Care Planning; Patient Preferences; Patient-Focused Outcomes; Patients; Persons; Population; Prevalence; Primary Health Care; Process; Psychosocial Factor; Psychosocial Influences; Public Health; Qualitative Methods; Randomized Controlled Trials; Reporting; Research; Research Personnel; Research Support; Sampling; Self Efficacy; Strategic Planning; Structure; Surveys; Symptoms; Testing; Time; Training; Training Activity; United States Agency for Healthcare Research and Quality; Writing; anxiety symptoms; anxious; base; biopsychosocial; career; daily functioning; depressive symptoms; disorder control; experience; health training; implementation science; improved; improved outcome; innovation; multiple chronic conditions; pragmatic trial; programs; psychologic; psychosocial; secondary analysis; service utilization; skills; social; tool; trial design

PROJECT SUMMARY 1 Many patients with multiple chronic conditions (MCC) have anxious and depressive symptoms and 2 unmet social needs (housing, food, finances). These are associated with worse health outcomes and high 3 healthcare costs. The Biopsychosocial Model provides a framework for conceptualizing the influence that 4 psychosocial factors have on the management of disease. To date, components of the model have not been 5 adequately assessed among patients with MCCs. Preliminary research has independently linked psychosocial 6 variables to MCC outcomes, though the psychological and social realms of the model have not been evaluated 7 as latent constructs. Further, lack of longitudinal studies leaves the temporal relation between psychosocial 8 factors and MCC management poorly understood. The proposed study will fill these gaps by conducting a 9 secondary analysis from an ongoing randomized controlled trial examining the effectiveness of enhanced care 10 planning for better managing MCC for 600 primary care practice patients (Enhanced Care Planning [ECP]; 11 AHRQ 1R01HS026223-01A1, PI Alex Krist). All patients in the sample will complete assessments of social 12 needs, mental health, daily functioning, and overall health at baseline, six-, and twelve-months. I will (1) 13 describe the prevalence of anxious and depressive symptoms, their relation to social needs, and patient 14 prioritization of needs, (2) assess components of the biopsychosocial model and the longitudinal relation 15 between anxiety/depressive symptoms, social needs and MCC management, (3) qualitatively explore 16 underlying factors (e.g. self-efficacy, locus of control) that contribute to improvements in patients’ MCC control. 17 Data sources include the care planning tool, surveys, the electronic health record (EHR), and semi-structured 18 interviews. This proposal has four training goals for the development of emerging expertise in: (1) the empirical 19 study of chronic disease management and implementation science; (2) the use of structural equation modeling; 20 (3) qualitative methods of data analysis; and (4) scholarly writing and presentation skills. The training plan 21 consists of core and supplemental activities for each goal, including coursework and didactics, SEM and 22 qualitative analysis workshops, individual mentorship, and dissemination activities. My mentorship team is 23 comprised of national leaders in the relevant topic areas who have an established record of collaborating 24 together; they will help me develop my own expertise. This training plan will inform the proposed study’s 25 completion and dissemination. Results are expected to advance our understanding of patient priorities with 26 psychosocial factors and priorities that lead to meaningful improvements in MCC. This award affords me with 27 protected time needed to complete the study and training activities. It will also allow me to develop expertise 28 and necessary skills for a career as an independent researcher. Results will serve as the foundation for my 29 research program to improve primary care interventions for mental health and uncontrolled MCC. This study 30 aligns with NIMH’s Strategic Plan, to ‘strengthen the public health impact of NIMH-supported research’.

项目摘要 1许多患有多种慢性病（MCC）的患者有焦虑和抑郁症状， 2未满足的社会需求（住房、食物、资金）。这些都与更糟糕的健康结果和高 3医疗费用生物心理社会模型提供了一个概念化影响的框架， 4种心理社会因素对疾病的管理有影响。到目前为止，该模型的组成部分尚未得到 5例在MCC患者中进行了充分评估。初步研究表明， MCC结果的6个变量，尽管该模型的心理和社会领域尚未进行评估 7、作为一种潜在的结构。此外，由于缺乏纵向研究， 对8个因素和MCC管理知之甚少。拟议的研究将填补这些空白， 9项次要分析来自一项正在进行的随机对照试验，检查加强护理的有效性 为600名初级保健实践患者制定更好地管理MCC的10项计划（加强护理计划[ECP]; 11 AHRQ 1R01HS026223-01A1，PI Alex Krist）。样本中的所有患者将完成社会风险评估。 12需求，心理健康，日常功能和基线，6个月和12个月的整体健康状况。我会的（1） 13描述焦虑和抑郁症状的患病率，它们与社会需求的关系， 14确定需求的优先次序，（2）评估生物心理社会模式的组成部分和 焦虑/抑郁症状、社会需求与MCC管理之间的关系;（3）定性探讨 有助于改善患者MCC控制的16个潜在因素（如自我效能、控制源）。 17数据源包括护理规划工具、调查、电子健康记录（EHR）和半结构化 18次面试这项建议有四个培训目标，以发展新兴的专门知识：（1）经验 19研究慢性病管理与实施科学;（2）运用结构方程建模; 20（3）数据分析的定性方法;（4）学术写作和演讲技巧。培训计划 21包括每个目标的核心和补充活动，包括课程和教学法，SEM和 22次定性分析讲习班、个人指导和传播活动。我的导师团队 23个由相关主题领域的国家领导人组成，他们在合作方面有着良好的记录 第24章我会帮助你发展我的专长本培训计划将告知拟议研究的 25篇完成与传播预计结果将促进我们对患者优先事项的理解， 26个心理社会因素和优先事项，导致有意义的改善，在MCC。这个奖给了我 完成学习和培训活动所需的27个保护时间。这也能让我发展专业知识 28和必要的技能作为一个独立的研究人员的职业生涯。结果将作为我的基础 29研究计划，以改善初级保健干预精神健康和不受控制的MCC。本研究 30符合NIMH的战略计划，以“加强NIMH支持的研究的公共卫生影响”。