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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

基本信息

批准号：
10656237
负责人：
Devin M Mann
金额：
$ 61.4万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10656237
关键词：
Adoption Adult Body Weight Changes Body Weight decreased Caring Certification Clinical Clinical Data Cluster randomized trial Collaborations Communication Complex Data Data Element Data Reporting Data Sources Diabetes Mellitus Diabetes prevention Effectiveness Electronic Health Record Environment Epidemic Feedback Glycosylated hemoglobin A Goals Health Personnel Health behavior Health behavior change Healthcare Healthcare Systems Intervention Investments 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 Care Process Proctor framework Provider Randomized Role System Technology Testing Time Visualization Visualization software Weight Work behavior change behavioral outcome commercialization cost data tools data visualization design diabetes prevention program diabetic patient digital digital health digital healthcare digital intervention digital tool direct application disorder prevention evidence base experience health data implementation evaluation implementation facilitators implementation outcomes implementation process implementation tool improved mobile computing multidisciplinary new technology novel participant enrollment patient engagement patient portal patient safety patient-clinician communication personalized care post implementation prevent primary care practice primary care setting primary care team programs recruit satisfaction success theories tool trial comparing usability user centered design

项目摘要

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.

数字版本的糖尿病预防计划（dDPPs）提供了一个令人兴奋的机会，将循证证据