Older Adults & Drug Decisions: Collaboration & Outcomes
老年人
基本信息
- 批准号:6656940
- 负责人:
- 金额:$ 53.22万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2002
- 资助国家:美国
- 起止时间:2002-09-15 至 2006-08-31
- 项目状态:已结题
- 来源:
- 关键词:audiotape clinical research clinical trials communication computer assisted medical decision making drug screening /evaluation functional ability human old age (65+) human subject longitudinal human study outcomes research pain patient care personnel relations physicians questionnaires rheumatoid arthritis
项目摘要
DESCRIPTION (provided by applicant): Midst growing time pressures on physicians, there is a need to maintain and even enhance the quality of physician-patient encounters, particularly for vulnerable, older adults with chronic conditions. Substantial research suggests that older adults are more passive than other age groups during their visits. Hence, physicians may miss key information about patient concerns and regimens that could affect health outcomes. This research addresses gaps identified by literature reviews calling for studies evaluating interventions that efficiently elicit patient pre-visit expectations for physicians and examine the longitudinal effect of expectation fulfillment on patient outcomes. The goal of this research is to study the impact of an intervention that identifies pre-visit concerns of older adult patients and then prompts both patients and physicians to address these concerns in the visit. Older adults' functional status concerns will be identified briefly in the waiting room using a handheld computer. A printout summarizing patient responses will be given both to the physician and patient. We hypothesize that this prompt will affect the nature of the patient-provider encounter in such a way that health outcomes will be improved. To test these hypotheses, a final sample of 580 patients age 60 or older, with a formal diagnosis of rheumatoid arthritis will be enrolled at their clinic visit. A one-year randomized, controlled experiment will be used in which an experimental group patients receive a computerized assessment and prompt about their visit concerns while a control group receives a parallel placebo computerized assessment of their exercise patterns. In both cases, patient assessment summaries are given to the patients and to their physicians in the medical record. Baseline, 6 month and 12 month data will be collected on each patient. We hypothesize improved health status at 12 months for the primary outcomes of pain and physical function. Selected encounter dynamics hypothesized to help explain these outcomes will also be examined. We will audiotape patient-physician encounters to study these interaction dynamics. The primary analyses will examine differences at 12 months between the control and experimental groups using ANCOVA for continuous variables with baseline values of outcomes as a covariate, Dichotomous outcomes will be analyzed primarily by the Mantel Haenszel test and logistic regression.
描述(由申请人提供):在医生的时间压力越来越大的情况下,有必要保持甚至提高医患接触的质量,特别是对于患有慢性疾病的脆弱老年人。大量研究表明,老年人在访问期间比其他年龄组的人更被动。因此,医生可能会错过可能影响健康结果的患者关注和治疗方案的关键信息。本研究解决了文献综述中发现的空白,这些文献综述呼吁研究评估干预措施,有效地引发患者对医生的就诊前期望,并检查期望实现对患者结果的纵向影响。本研究的目的是研究一项干预措施的影响,该干预措施确定了老年患者就诊前的担忧,然后提示患者和医生在就诊时解决这些担忧。老年人的功能状态问题将在候诊室使用掌上电脑进行简单识别。医生和病人都将得到一份总结病人反应的打印件。我们假设这一提示将影响患者与提供者接触的性质,从而改善健康结果。为了验证这些假设,580名年龄在60岁或以上、正式诊断为类风湿关节炎的患者将被纳入最终样本。在为期一年的随机对照实验中,实验组患者接受计算机评估并提示他们的就诊问题,而对照组患者接受平行的安慰剂计算机评估他们的锻炼模式。在这两种情况下,患者评估摘要都在医疗记录中提供给患者和他们的医生。每位患者的基线、6个月和12个月数据将被收集。我们假设在12个月时,疼痛和身体功能的主要结局改善了健康状况。选择的相遇动力学假设,以帮助解释这些结果也将进行检查。我们将录下病人与医生的接触,以研究这些互动动力学。主要分析将使用ANCOVA对连续变量(结果基线值作为协变量)检查对照组和实验组之间12个月的差异,二分类结果将主要通过Mantel Haenszel检验和逻辑回归进行分析。
项目成果
期刊论文数量(0)
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科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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