Improving glaucoma self-management with technology-supported counselors

通过技术支持的咨询师改善青光眼自我管理

• 批准号: 9264536
• 负责人: Paula Anne Newman-Casey
• 金额: $ 23.27万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9264536
• 关键词: Address; Adherence; Affect; Age; Aging; Award; Behavior; Behavioral; Blindness; Caring; Chronic Disease; Clinic; Clinic Visits; Clinical; Clinical Research; Communication; Complex; Computer Simulation; Computers; Counseling; Data; Disease; Education; Engineering; Evaluation; Eye; Focus Groups; Foundations; Glaucoma; Goals; Health; Health Communication; Health Technology; Health system; Healthcare; Individual; Industry; Institute of Medicine (U.S.); Intervention; Light; Literature; Mediator of activation protein; Medical; Mentored Clinical Scientist Development Program; Mentors; Mentorship; Methods; Mission; Modeling; Monitor; Motivation; Online Systems; Ophthalmologist; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Phonation; Physicians; Physiologic Intraocular Pressure; Population; Prevalence; Process; Professional counselor; Provider; Psychology; Randomized Clinical Trials; Research; Research Design; Research Personnel; Schedule; Scientist; Self Efficacy; Self Management; Services; Societies; Stream; System; Techniques; Technology; Telephone; Testing; Text; Theoretical model; Time; Training; United States; United States National Institutes of Health; Visual impairment; Work; base; behavior change; career; clinical practice; cost; design; effective therapy; evidence base; eye center; health care delivery; improved; improved outcome; innovation; intervention effect; manufacturing process; medical specialties; medication compliance; member; motivational enhancement therapy; operation; patient oriented; performance tests; prevent; process optimization; programs; prototype; psychosocial; public health relevance; satisfaction; secondary outcome; simulation; skills; standard care; systematic review; theories; therapy design; tool

 DESCRIPTION (provided by applicant): Glaucoma is a leading cause of irreversible blindness in the United States. Yet, at least one-half of glaucoma patients do not take the medications that are proven to prevent vision loss. Current clinical practice lacks a strategic framework to address this issue. The overarching objective of the proposal is to improve adherence while maximizing the efficiency of our ophthalmic healthcare workforce. The project aims to leverage technology to support medical provider teams to deliver high-quality individualized education and counseling that would otherwise be available only through an extended conversation with a physician. The project will use operations engineering (OE), a field whose goal is to optimize efficiency in complex systems and processes, to provide a framework to increase the efficiency of clinic visits in order to integrate individualized counseling and support into standard care. OE tools will be used to analyze scheduling, work- flow and work-allocations to optimize the application of team-based eye care to improve support for patient's self-management behaviors. The proposed counseling strategy will be designed to maintain patient access to glaucoma specialty services by allowing the same level of patient volume. This work will refine and pilot test the eyeGuide, a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence. The PI and her mentorship team have developed a prototype of the eyeGuide. In this program, medical assistants are trained in motivational interviewing-based approaches to use the eyeGuide to deliver individualized information and coaching to each patient. The eyeGuide will be refined based on information gathered in an operations engineering (OE) analysis of current clinical practice. OE value stream mapping will be used to identify when to include additional education and counseling during a patient's clinic visits. OE computer modeling techniques will be used to generate different theoretical models in which to test how to optimally integrate additional counseling and education into glaucoma patient care. The eyeGuide program will be refined based on these analyses and pilot tested with non-adherent glaucoma patients. Its effect on adherence, monitored in real time, and psychosocial mediators of adherence will be evaluated. The proposed training and research will prepare Dr. Newman-Casey to become an independent glaucoma researcher, with skills in effective health communication, operations engineering, and mixed methods intervention design and analysis. In light of the growing prevalence of glaucoma as the US population ages and concomitant projected shortages of ophthalmologists, the design, implementation and evaluation of systems-based approaches towards an improved model of patient centered eye care is critically important.

 描述（由申请人提供）：青光眼是美国不可逆失明的主要原因。然而，至少有一半的青光眼患者没有服用被证明可以预防视力丧失的药物。当前的临床实践缺乏解决这个问题的战略框架。该提案的总体目标是提高依从性，同时最大限度地提高我们眼科医疗保健人员的效率。该项目旨在利用技术支持医疗服务提供者团队提供高质量的个性化教育和咨询，而这些教育和咨询只能通过与医生的长期对话才能获得。该项目将利用运营工程（OE）这一领域，其目标是优化复杂系统和流程的效率，提供一个框架来提高诊所就诊的效率，以便将个性化咨询和支持整合到标准护理中。 OE 工具将用于分析日程安排、工作流程和工作分配，以优化基于团队的眼保健应用，从而改善对患者自我管理行为的支持。拟议的咨询策略将旨在通过允许相同水平的患者数量来维持患者获得青光眼专业服务的机会。 这项工作将完善并试点测试 eyeGuide，这是一个基于计算机的个性化行为改变计划，使经过简短培训的医疗助理能够激励和支持青光眼患者改善自我管理和药物依从性。 PI 和她的指导团队开发了 eyeGuide 的原型。在此计划中，医疗助理接受基于动机访谈的方法的培训，以使用 eyeGuide 向每位患者提供个性化信息和指导。 eyeGuide 将根据当前临床实践的运营工程 (OE) 分析中收集的信息进行完善。 OE 价值流图将用于确定何时在患者就诊期间包括额外的教育和咨询。 OE 计算机建模技术将用于生成不同的理论模型，以测试如何将额外的咨询和教育最佳地整合到青光眼患者护理中。 eyeGuide 计划将根据这些分析进行完善，并在非依从性青光眼患者中进行试点测试。将评估其对依从性的影响、实时监测以及依从性的心理社会调节因素。 拟议的培训和研究将使纽曼-凯西博士成为一名独立的青光眼研究员，具备有效的健康沟通、运营工程以及混合方法干预设计和分析方面的技能。鉴于随着美国人口老龄化，青光眼患病率不断上升，以及随之而来的眼科医生短缺，设计、实施和评估基于系统的方法以改进以患者为中心的眼保健模式至关重要。