The impact of sharing audio recorded clinic visits on self-management in older adults: a multisite trial

共享就诊录音对老年人自我管理的影响：多中心试验

• 批准号: 10017803
• 负责人: PAUL JAMES BARR
• 金额: $ 75.61万
• 依托单位: DARTMOUTH COLLEGE
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017803
• 关键词: Address; Adherence; Awareness; Caregiver support; Caregivers; Caring; Chronic; Client satisfaction; Clinic; Clinic Visits; Clinical; Complex; Confusion; Data; Diagnosis; Effectiveness; Elderly; Emergency department visit; Expenditure; Future; Goals; Health; Healthcare; Hospitalization; Hypersensitivity; Individual; Influentials; Intervention; Interview; Knowledge; Lead; Measures; Mediating; Medical; Medicare; Mental Depression; Outcome; Patients; Pharmaceutical Preparations; Physical Function; Policies; Primary Health Care; Process; Public Health; Quality of life; Randomized; Recommendation; Reporting; Research; Role; Sampling; Schedule; Self Management; Site; Structure; Surveys; Testing; Time; Visit; Work; base; burden of illness; chronic care model; clinical practice; cognitive capacity; design; experience; functional decline; functional status; health care service utilization; health literacy; health management; high risk; implementation research; implementation strategy; improved; innovation; medical specialties; mental function; multi-site trial; multiple chronic conditions; novel; older patient; routine care; skills; systematic review; treatment as usual; treatment planning; uptake

PROJECT SUMMARY Up to eighty percent of clinic visit information is forgotten by patients immediately post visit. This is a significant barrier to self-management, especially in older adults with multimorbidity leading to poor health outcomes. After visit summaries (AVS) can improve recall, yet concerns exist about their layout, accuracy and low patient uptake. Patients and clinicians have begun audio recording clinic visits. When patients receive an audio recording of the visit, 71% listen and 68% share it with a caregiver, resulting in greater recall. Despite its growing use, to date there is no research on the impact of recording and sharing clinic visits of patient self- management ability, health outcomes or healthcare utilization. The objective of this proposal is to conduct a multi-site trial evaluating the impact of adding an audio recording of clinic visits (AUDIO) to usual care in older adults with multimorbidity, compared to AVS alone (Usual Care; UC). The specific aims are: Aim 1 Conduct a three-site trial in primary care where older patients with multimorbidity (n=540) will be randomized to receive an AVS plus audio recording (AUDIO) versus AVS alone (UC) for all scheduled clinic visits over 12 months; patients will be assessed at baseline, 1 week, 6 months and 12 months; Aim 2 Investigate and describe barriers and facilitators of the implementation of audio recordings among patients, caregivers, clinicians and clinic staff. Applicants hypothesize: (1a) Compared to those receiving the AVS alone (UC), patients randomized to also receive audio recordings (AUDIO) of clinic visits will report a greater self-management ability (measured by the Patient Activation Measure–Short Form) at 12 months. Applicants will also explore the impact of AUDIO on the clinic visit, health outcomes, healthcare utilization and whether these impacts are mediated by PAM-SF; (1b) The effect of AUDIO on self-management compared to UC will be greater for patients with low health literacy than for those with high health literacy. Applicants will explore whether the impact of audio recordings is greater for individuals with caregiver support or at highest risk of poor self- management, e.g., high disease burden, moderate to severe depression. In Aim 2, applicants will investigate factors related to the implementation of audio recording and develop recommendations for an implementation toolkit to guide future dissemination of recording. The research is innovative because: i) it seeks to shift current clinical practice where visit information is provided via AVS, by adding audio recording; ii) the routine provision of visit recordings over time moves beyond prior studies that focus on single recordings of specialty visits; and iii) a trial in real-world settings of patients with multimorbidity, regularly excluded from trials, is novel and has greater external validity. The results are expected to have a major positive impact as they will increase clinical understanding of the impact and implementation of audio recording on the significant challenge of improving patient self-management especially in the face of the public health burden of multimorbidity.

项目摘要 高达80%的门诊访视信息在访视后立即被患者遗忘。这是一个重大 自我管理的障碍，特别是在老年人与多morphis导致健康状况不佳的结果。 访视后摘要（AVS）可以提高回忆率，但存在布局，准确性和低患者 摄取。病人和临床医生已经开始录音诊所访问。当患者收到音频时， 在记录访问时，71%的人会倾听，68%的人会与照顾者分享，从而产生更大的回忆。尽管 越来越多的使用，到目前为止，还没有研究记录和共享患者自我诊所访问的影响， 管理能力、健康结果或医疗保健利用率。这项建议的目的是进行一项 一项多中心试验，评价在老年人常规护理中增加门诊访视音频记录（AUDIO）的影响 与单独的AVS相比，患有多发性硬化症的成年人（泌尿系护理; UC）。具体目标如下：目标1 一项初级保健的三中心试验，其中患有多发性硬化症的老年患者（n=540）将随机接受 12个月内所有计划门诊访视的AVS+音频记录（AUDIO）与AVS单独（UC）比较; 将在基线、1周、6个月和12个月时对患者进行评估;目标2调查并描述 患者、护理人员、临床医生和 诊所工作人员申请人假设：（1a）与接受单独AVS（UC）的患者相比， 随机接受门诊访视录音（AUDIO）的患者将报告更好的自我管理 12个月时的能力（通过患者激活测量简表测量）。申请人还将探索 AUDIO对门诊、健康结局、医疗保健利用的影响，以及这些影响是否 PAM-SF介导;（1b）与UC相比，AUDIO对自我管理的影响更大， 健康素养低的患者比健康素养高的患者更易患糖尿病。申请人将探讨 录音的影响对于有照顾者支持或自我不良风险最高的个人来说更大， 管理，例如，高疾病负担，中度至重度抑郁。在目标2中，申请人将调查 与实施录音有关的因素，并为实施 指导今后传播记录的工具包。这项研究是创新的，因为：i）它试图改变电流 通过AVS提供访视信息的临床实践，通过添加音频记录; ii）常规提供 随着时间的推移，访视记录的变化超出了以往的研究，这些研究侧重于专科访视的单一记录;以及 iii）在经常被排除在试验之外的多Morphine患者的真实世界环境中进行的试验是新颖的， 更大的外部有效性。这些结果预计将产生重大的积极影响，因为它们将增加临床 了解录音的影响和实施对改善的重大挑战， 病人自我管理，特别是在面对多重死亡的公共卫生负担时。