权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

ACCTiVATE: Achieving Chronic Care equiTy by leVeraging the Telehealth Ecosystem

ACCTiVATE：利用远程医疗生态系统实现慢性病护理公平

基本信息

批准号：
10780135
负责人：
Delphine Tuot
金额：
$ 47.84万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-25 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10780135
关键词：
Address Adoption Adult Affect American Appointment Asian Black Populations Black race Blood Pressure COVID-19 pandemic Cardiovascular Diseases Cardiovascular system Caring Cessation of life Child Care Chronic Chronic Care Chronic Disease Chronic Kidney Failure Clinic Clinical Communication Communities Community Health Community Health Aides Competence Data Development Devices Diabetes Mellitus Disease Management Disease Outcome Disparity Ecosystem Effectiveness Electronics Equity Ethnic Origin Evaluation Face Federally Qualified Health Center Glycosylated Hemoglobin Glycosylated hemoglobin A Goals Health Health Status Health Technology Healthcare Hypertension Individual Inequity Internet Intervention Interview Latinx Latinx population Learning Linguistics Low income Methods Microalbuminuria Minority Groups Modality Morbidity - disease rate Outcome Patient Preferences Patients Persons Process Process Measure Provider Public Health Race Randomized Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Reduce health disparities Risk Factors Role San Francisco Self Efficacy Self Management Stroke System Technology Telemedicine Telephone Training Support Transportation United States Visit Voice Work arm cardiovascular health cardiovascular risk factor care delivery clinical care dashboard digital digital health digital technology ethnic disparity ethnic diversity ethnic minority ethnic minority population experience health care delivery health care disparity health data health disparity health equity hypertension control implementation determinants implementation evaluation implementation framework implementation intervention implementation outcomes implementation strategy improved interest literacy low socioeconomic status marginalization medication compliance minority patient mortality multidisciplinary operation outcome disparities pandemic disease patient engagement patient level intervention patient oriented patient portal patient-level barriers preference primary outcome programs racial disparity racial diversity racial minority racial minority population remote patient monitoring safety net shared decision making skills skills training socioeconomic disparity telehealth tool treatment as usual video visit

项目摘要

PROJECT SUMMARY/ABSTRACT Chronic diseases such as hypertension, diabetes and chronic kidney disease cause significant mortality, with stark inequities impacting racially and ethnically minoritized populations. The COVID-19 pandemic prompted a rapid shift in chronic disease management to telehealth-based care, including patient portals, telemedicine video visits, and remote patient monitoring. However, there are substantial racial/ethnic and socioeconomic disparities in health IT access for chronic disease management in the United States. This is due to patient-level barriers such as inequitable device and internet access and lower digital literacy, as well as clinic-level barriers such as inadequate support to access digital technologies and skills, inequitable offering of health IT, and a lack of equity-focused, stratified telehealth data. Increasing telehealth use among minority populations has the potential to lessen disparities in chronic disease health outcomes. We propose a 2x2 randomized controlled trial entitled “Achieving Chronic Care equiTy by leVerAging the Telehealth Ecosystem” (ACCTiVATE), in which we will examine the impact of a multi-level intervention that tackles patient-level and clinic-level barriers to increase the equitable use of health IT for chronic disease management. The patient-level intervention combines the role of digital health navigator and chronic disease health coach to facilitate access to devices and broadband, offer digital skills training, and provide chronic disease health coaching focused on telehealth modalities. The clinic-level intervention includes Practice Facilitation with a learning collaborative, clinic-specific Community Advisory Boards, and electronic “Telehealth Equity Dashboards” that display telehealth utilization stratified by race/ethnicity. We will randomize 600 English- and Spanish-speaking adults with uncontrolled hypertension across 10 federally qualified health centers to digital coaching versus usual care. The 10 health centers will be randomized to Practice Facilitation versus usual care. In Aim 1, we will assess the impact of the multi-level intervention (coaching combined with practice facilitation, and each arm alone) on systolic blood pressure (primary outcome), hemoglobin A1c, and microalbuminuria overall, and among Black and Latinx patients. In Aim 2, we will assess impacts on process measures of telehealth disease management (digital literacy, medication adherence, engagement with health IT). In Aim 3, we will conduct a mixed methods evaluation of implementation by applying the RE-AIM framework to identify key features needed for successful adoption and dissemination by healthcare networks. A multidisciplinary Stakeholder Advisory Board will advise on all Aims. The proposed intervention recognizes the multilevel determinants that have perpetuated the digital divide, worsening chronic disease care during the pandemic. The impact of this intervention will result in an efficient, user-centered multilevel intervention for improved telehealth engagement, medication adherence, and digital literacy, which are all key drivers of improved chronic disease outcomes.

项目总结/文摘