Amplifying provider impact on patient engagement with an EHR- integrated digital diabetes prevention program

通过 EHR 集成数字糖尿病预防计划，扩大医疗服务提供者对患者参与度的影响

• 批准号: 9815834
• 负责人: Devin M Mann
• 金额: $ 69.59万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9815834
• 关键词: Adoption; Adult; Body Weight Changes; Body Weight decreased; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Clinical; Clinical Data; Cluster randomized trial; Communication; Complex; Data; Data Element; Data Reporting; Data Sources; Diabetes Mellitus; Diabetes prevention; Effectiveness; Electronic Health Record; Enrollment; Environment; Epidemic; Feedback; Glycosylated hemoglobin A; Goals; Health Personnel; Health behavior; Health behavior change; Healthcare; Healthcare Systems; Imagery; Intervention; Life Style; Link; Measurable; Medical Care Team; Methods; Modeling; Modernization; Notification; Outcome; Pathway interactions; Patient Monitoring; Patients; Perception; Phase; Physical activity; Prediabetes syndrome; Prevention program; Primary Health Care; Process; Provider; Randomized; Role; System; Technology; Testing; Time; Visualization software; Weight; Work; base; behavior change; behavioral outcome; combat; cost; data visualization; design; diabetes prevention program; digital; disorder prevention; evidence base; experience; health application; health data; improved; mobile computing; multidisciplinary; new technology; novel; patient engagement; patient portal; patient safety; patient-clinician communication; personalized care; prevent; primary care setting; programs; recruit; satisfaction; success; theories; tool; trial comparing; usability; user centered design

Digital versions of diabetes prevention programs (dDPPs) offer an exciting opportunity to bring evidence-based DPPs to scale across the nation. dDPPs have been validated, CDC-recognized, commercialized, modernized on ubiquitous mobile platforms and are increasingly reimbursable. Automated sharing of dDPP patient- generated health data with the primary care team is now possible. However, no empiric data are available to guide the meaningful integration of this new data source within electronic health records (EHRs) or clinical workflows to support patient engagement in the dDPP. Healthcare providers need concise, actionable data to replace the large amounts of clinical data presented in the EHR that is increasingly scattered, conflicted, and poorly filtered, threatening patient safety and provider satisfaction. Our team, which built the first dDPP used in primary care, recently developed and tested a novel system that links this digital behavior change program with an EHR to create an enhanced visualization tool. This tool pushes meaningful visualizations of key dDPP data elements (e.g. weight, activity, lesson completion) directly into the complex EHR workflows of primary care to enhance patient engagement. Based on this prior work, we now seek to determine the impact of implementing our enhanced visualization tool in combination with other widely available EHR messaging and notification functionality (dDPP-EHR tool suite) for diabetes prevention in real-world primary care practice. To achieve this goal we propose 3 aims: 1) to adapt our suite of digital patient monitoring and engagement tools that will integrate patient dDPP data into the EHR workflow; 2) to conduct a pragmatic, clustered RCT in 40 primary care practices to observe the suite’s impact on patient engagement, weight loss, physical activity, and HbA1C among prediabetic patients enrolled in the dDPP; and 3) to evaluate the implementation process guided by the Technology Acceptance Model (TAM3) and Proctor’s Implementation Outcomes Framework. The dDPP-EHR tool suite adaptation phase is guided by a user-centered design process consisting of group feedback sessions, workflow analyses and agile design to refine the suite’s integration into existing clinical workflows. The suite of tools and optimized workflows will be linked to the dDPP from a collaborating commercial dDPP provider (Noom, Inc). Each primary care practice will then be randomly assigned to have (or not have) access to the tool while patients (10 per practice) are recruited via patient portal to receive a dDPP prescription from their provider. The main outcomes will be weight loss, physical activity, HbA1C and dDPP engagement over the 1-year intervention. Aim 3 will use a theory driven implementation assessment framework to assess the acceptability, adoption, cost, and sustainability of implementing the dDPP-EHR tool. We have assembled an experienced, multi-disciplinary team that includes a leading commercial digital diabetes prevention program provider to determine if connecting patients and providers through our novel dDPP-EHR tool suite has a measurable impact on diabetes prevention-related outcomes.

糖尿病预防计划（dDPP）的数字版本提供了一个令人兴奋的机会， DPP将在全国范围内推广。dDPP已经过验证，CDC认可，商业化，现代化 在无处不在的移动的平台上，并且越来越多地得到补偿。dDPP患者的自动共享- 现在可以与初级保健团队一起生成健康数据。然而，没有经验数据可用于 指导将这种新数据源与电子健康记录（EHR）或临床 支持患者参与dDPP的工作流程。医疗保健提供商需要简洁、可操作的数据， 取代EHR中呈现的大量临床数据，这些数据越来越分散，相互矛盾， 过滤不良，威胁患者安全和提供者满意度。我们的团队构建了第一个用于的dDPP 初级保健，最近开发和测试了一个新的系统，将这个数字行为改变计划与 一个EHR来创建一个增强的可视化工具。此工具可推动关键dDPP数据的有意义的可视化 元素（例如体重，活动，课程完成）直接进入初级保健的复杂EHR工作流程， 提高患者参与度。基于这一先前的工作，我们现在寻求确定实施 我们增强的可视化工具与其他广泛使用的EHR消息传递和通知相结合 功能（dDPP-EHR工具套件），用于实际初级保健实践中的糖尿病预防。实现这一 我们提出了3个目标：1）调整我们的数字患者监测和参与工具套件， 将患者dDPP数据整合到EHR工作流程中; 2）在40个主要的 护理实践，以观察该套件对患者参与度、体重减轻、体力活动和HbA 1C的影响 在dDPP中招募的前驱糖尿病患者中;和3）评估由 技术接受模型（TAM 3）和普罗克特的实施成果框架。dDPP-EHR 工具套件适应阶段由以用户为中心的设计过程指导，该过程包括小组反馈 会议、工作流程分析和敏捷设计，以完善该套件与现有临床工作流程的集成。 这套工具和优化的工作流程将从一个合作的商业dDPP链接到dDPP 提供商（Noom，Inc.）。每个初级保健实践将被随机分配到有（或没有）访问 使用该工具，同时通过患者门户招募患者（每个诊所10名），以接收dDPP处方 他们的供应商。主要结果将是体重减轻，身体活动，HbA 1C和dDPP参与超过 一年的干预。目标3将使用理论驱动的实施评估框架来评估 实施dDPP-EHR工具的可接受性、采用性、成本和可持续性。我们制定了一份 经验丰富的多学科团队，包括领先的商业数字糖尿病预防计划 提供者，以确定是否通过我们的新型dDPP-EHR工具套件连接患者和提供者， 对糖尿病预防相关结果的可衡量影响。