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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.

项目概要/摘要高血压、糖尿病和慢性肾病等慢性病导致大量死亡，严重的不平等影响着种族和族裔少数群体。 COVID-19 大流行引发了慢性病管理迅速转向基于远程医疗的护理，包括患者门户、远程医疗视频访问和远程患者监控。然而，存在大量的种族/民族和社会经济因素美国慢性病管理的卫生 IT 接入方面存在差异。这是由于患者水平设备和互联网接入不公平、数字素养较低等障碍，以及诊所层面的障碍例如，对获取数字技术和技能的支持不足、卫生信息技术的提供不公平以及缺乏注重公平的分层远程医疗数据。少数族裔人群中远程医疗使用的增加缩小慢性病健康结果差异的潜力。我们提出了一项 2x2 随机对照试验，题为“通过利用远程医疗生态系统”（ACCTiVATE），其中我们将研究多层次干预的影响，解决患者层面和诊所层面的障碍，以增加健康信息技术在慢性病治疗中的公平使用管理。患者层面的干预结合了数字健康导航仪和慢性病的作用健康教练，以促进设备和宽带的使用，提供数字技能培训，并提供长期疾病健康辅导侧重于远程医疗方式。临床层面的干预包括实践通过学习协作、特定于诊所的社区咨询委员会和电子“远程医疗”来促进公平仪表板”显示按种族/民族分层的远程医疗利用率。我们将随机抽取 600 名讲英语和西班牙语的成年人，他们的高血压不受控制，分布在 10 个年龄段联邦合格的健康中心进行数字化辅导与常规护理。这10个卫生中心将随机分为练习促进组和常规护理组。在目标 1 中，我们将评估多层次的影响对收缩压的干预（辅导结合练习促进，每只手臂单独进行）（主要结果）、总体血红蛋白 A1c 和微量白蛋白尿，以及黑人和拉丁裔患者。在目标 2，我们将评估对远程医疗疾病管理流程措施的影响（数字素养、药物依从性、健康信息技术的参与）。在目标 3 中，我们将进行混合方法评估通过应用 RE-AIM 框架来确定成功采用和实施所需的关键功能通过医疗保健网络进行传播。多学科利益相关者咨询委员会将为所有目标提供建议。拟议的干预措施认识到导致数字鸿沟长期存在的多层次决定因素，大流行期间慢性病护理恶化。这种干预的影响将导致有效的、以用户为中心的多层次干预，以改善远程医疗参与度、药物依从性和数字化识字率，这些都是改善慢性病结果的关键驱动因素。