Leveraging mobile health technology to reduce avoidable healthcare utilization in persons with Alzheimer's Disease and Related Dementias in adult day centers

利用移动医疗技术减少成人日间中心阿尔茨海默病和相关痴呆症患者本可避免的医疗保健利用率

• 批准号: 10414971
• 负责人: Tina Sadarangani
• 金额: $ 16.74万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414971
• 关键词: Access to Information; Acute; Address; Adoption; Adult; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Behavior Therapy; Caregivers; Caring; Categories; Clinical; Communication; Communities; Community Health Systems; Continuity of Patient Care; Country; Data; Dementia; Development; Early Diagnosis; Early Intervention; Elderly; Electronic Health Record; Elements; Emergency department visit; Enrollment; Family; Feedback; Focus Groups; Formal caregiver; Future; Goals; Growth; Health; Health Status; Health Technology; Health system; Healthcare; Hospital Costs; Hospitalization; Individual; Integrated Health Care Systems; Intervention; Interview; Knowledge; Low income; Maps; Medical; Medical Records; Medical emergency; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Minor; Mobile Health Application; Modeling; Notification; Nurses; Outcome; Patients; Persons; Positioning Attribute; Principal Investigator; Process; Provider; Public Health Practice; Quality of Care; Registered nurse; Research; Research Personnel; Resources; Scientist; Services; Social Workers; Statutes and Laws; Surveys; System; Technology; Testing; Time; Training; Treatment Efficacy; Triad Acrylic Resin; Tweens; United States; United States National Institutes of Health; Visual; Vulnerable Populations; Work; acceptability and feasibility; behavior test; care providers; chronic care model; community based care; community setting; cost; design; disparity reduction; eHealth; efficacy testing; experience; facsimile; feasibility testing; functional status; handheld mobile device; health care delivery; health care service utilization; health care settings; health information technology; improved; informal caregiver; innovation; interoperability; mHealth; novel; product development; programs; prototype; racial diversity; racial minority; smartphone Application; social; therapy development; user centered design; vulnerable community

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoida- ble emergency department (ED) visits and hospitalizations. Adult day service centers (ADCs) provide commu- nity-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily as- sessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to communicate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve communication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an inde- pendent scientist who leads a research program that integrates care from ADCs and PCPs using mHealth in- terventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to ad- dress health care utilization disparities, developing mHealth interventions using user-centered design princi- ples, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) identify the key domains of an mHealth application intended to support communication be- tween ADCs, PCPs, and informal caregivers regarding the health-related needs of PLWD; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and in- formal caregivers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth applica- tion use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6-month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve standards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access information from their medical records using their preferred smartphone application. This study is innovative because it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the develop- ment of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.

项目摘要。痴呆症（PLWD）的社区居民非常容易避免 - BLE急诊科（ED）就诊和住院。成人日服务中心（ADC）提供通讯 基于越来越多的大约潜水员的PLWD的护理，其中大多数是低收入的。每日 ADC跨学科工作人员的会议和序列观察（包括注册护士，社会 工人和计划主管）支持PLWD中临床问题的早期检测。但是，当急性时 健康状况发生变化，希望向初级保健提供者及时通知的ADC员工 （PCP）经常无法有效地这样做。在我先前的研究中，我发现ADC员工对传真或 语音邮件消息以传达紧急信息。这导致了PCP的延迟或非响应 并允许较小的健康问题升级为医疗紧急情况。作为ADC中PLWD的数量 成长，迫切需要加强ADC之间的显着临床信息的沟通， PCP和护理人员减少昂贵的住院和ED访问。移动健康（MHealth）干预措施 已被证明可以改善各种医疗保健的沟通和临床信息交流 设置，但不是为ADC设计的。我寻求K23奖的目标是成为一个统治 吊坠科学家领导了一项研究计划，该研究计划使用MHealth In-In-In-将ADC和PCP的护理集成 减少PLWD中可避免的医疗保健利用率差异的服务。在经验丰富的 跨学科的心态团队，我将在三个领域接受培训：使用综合卫生系统来进行广告 着装医疗保健利用差距，使用以用户为中心的设计原理制定MHealth干预措施 PLE，设计和测试行为干预措施。在必要的培训中，我将执行以下操作 具体目的：（1）确定旨在支持沟通的MHealth应用程序的关键领域。 Tweet ADC，PCP和非正式护理人员有关PLWD的健康相关需求； （2）设计和测试 MHealth应用程序的视觉布局旨在支持ADC，PCP和IN-之间的通信 PLWD的正式护理人员； （3）开发和检查MHealth应用的可行性和可接受性 - ADC工作人员，PCP和非正式护理人员在减少住院和ED访问中的使用 在6个月的时间内。我的发现将为未来的R01提案提供信息，以测试使用的效率 完全运行的MHealth应用程序。这项研究很重要，因为这些发现将用于改进 护理标准并降低PLWD的成本和创伤结果。它还促进了立法 国家健康信息技术协调员办公室，要求患者能够访问 使用他们的首选智能手机应用程序从他们的病历中获取信息。这项研究是创新的 因为它利用ADC的优势并结合了前线提供商的观点，以告知发展 - 务实的以用户为中心的MHealth应用程序来整合PLWD中的护理并减少分布。