Mobile Patient-Reported Outcomes for Value and Effectiveness (mPROVE)

移动患者报告的价值和有效性结果 (mPROVE)

• 批准号: 10246841
• 负责人: Jane Jih
• 金额: $ 39.87万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246841
• 关键词: Mobile; Patient; Reported; Outcomes; Value

PROJECT SUMMARY/ABSTRACT Over half of Americans have at least one chronic disease, which include depression, diabetes, and hypertension. By definition, chronic diseases are 24/7 and impact all aspects of our patients' lives. It is thus patients themselves - through self-management of medication, lifestyle, exercise, and nutrition - who have the greatest potential to improve their disease states. Effective self-management requires timely and actionable feedback to patients on how their behavior impacts outcomes that are personally meaningful to them. Patient- reported outcomes (PROs) of symptoms such as depression, anxiety, mood, sleep, and cognitive function are of interest and meaningful to almost all patients with chronic conditions. When shared with providers, such PRO information can provide a singular view of the patient's perspective to inform shared decision-making. The ubiquitous nature of chronic diseases and the need for 24/7/anywhere data collection and feedback call for a mobile solution. With over 75% of Americans owning a smartphone, we can now use personal mobile technologies to collect and view PROs as never before possible. To date, we have secured key institutional support for a mobile PRO strategy at the University of California San Francisco (UCSF). UCSF's Division of General Internal Medicine (DGIM) serves a population of 25,000 primary care patients who reflect the ethnic and cultural diversity of the Bay Area, with over half of patients being racial/ethnic minorities and 21% Asian. Accordingly, we propose to develop the Mobile Patient-Reported Outcomes for Value and Effectiveness (mPROVE) system in English, Spanish, and Chinese for patient self-care and shared decision-making (Aim 1). Patients will use a smartphone app to collect and view PROs such as the PROMIS-29 and the novel Photographic Affect Meter visual PRO that assesses mood via a set of images. To make the PRO results seamlessly available to providers within their workflow, we will integrate mPROVE into UCSF's Epic electronic health record (EHR) and into UCSF's primary care workflow (Aim 2). We will use cutting-edge SMART-on-FHIR technology to embed PRO results into a window in the patient's EHR encounter without requiring any login by the provider. After conducting participatory design sessions, field testing, workflow prototyping, and pilot testing with patients, providers, and clinic staff, we will evaluate mPROVE using a Type 2 hybrid effectiveness-implementation study (Aim 3). Quality of care and implementation outcomes will be evaluated by a single-arm prospective interventional cohort study of 120 DGIM patients. Main effectiveness outcomes are PROMIS-29 health-related quality of life, shared decision-making, and self-efficacy. Main implementation outcomes include rates of PRO collection and PRO dashboard usage. mPROVE success will demonstrate a PRO intervention and implementation strategy that serves diverse populations, can be generalized to non-traditional PROs including novel visual PROs, and meets the needs of both patients and providers for using PROs in the care of patients with multiple chronic conditions.

项目概要/摘要 超过一半的美国人至少患有一种慢性病，其中包括抑郁症、糖尿病和 高血压。根据定义，慢性病是 24/7 的，影响患者生活的各个方面。正是如此 患者本身 - 通过药物、生活方式、锻炼和营养的自我管理 - 他们拥有 改善其疾病状态的最大潜力。有效的自我管理需要及时且可操作 向患者反馈他们的行为如何影响对他们个人有意义的结果。病人- 抑郁、焦虑、情绪、睡眠和认知功能等症状的报告结果 (PRO) 是 对几乎所有慢性病患者都感兴趣且有意义。当与提供商共享时，例如 PRO 信息可以提供患者观点的单一视图，为共同决策提供信息。 慢性病的普遍性以及 24/7/随时随地数据收集和反馈电话的需求 用于移动解决方案。超过 75% 的美国人拥有智能手机，我们现在可以使用个人移动设备 以前所未有的方式收集和查看 PRO 的技术。迄今为止，我们已获得关键机构 支持加州大学旧金山分校 (UCSF) 的移动 PRO 战略。 UCSF 的部门 普通内科 (DGIM) 为 25,000 名初级保健患者提供服务，这些患者反映了种族 湾区的文化多样性，超过一半的患者是少数族裔，21% 是亚裔。 因此，我们建议开发移动患者报告结果以实现价值和有效性 (mPROVE) 系统有英语、西班牙语和中文版本，用于患者自我护理和共同决策 （目标 1）。患者将使用智能手机应用程序来收集和查看 PROMIS-29 和小说等 PRO 摄影情感计视觉专业版，通过一组图像评估情绪。取得 PRO 结果 提供商在其工作流程中无缝可用，我们将把 mPROVE 集成到 UCSF 的 Epic 中 电子健康记录 (EHR) 并纳入 UCSF 的初级保健工作流程（目标 2）。我们将用最尖端的 SMART-on-FHIR 技术可将 PRO 结果嵌入到患者 EHR 就诊的窗口中，而无需 要求提供商进行任何登录。进行参与式设计会议、现场测试、工作流程后 通过原型设计以及与患者、提供者和诊所工作人员进行的试点测试，我们将使用类型来评估 mPROVE 2 混合有效性实施研究（目标 3）。护理质量和实施结果将 通过对 120 名 DGIM 患者进行的单臂前瞻性介入队列研究进行评估。主要功效 结果是 PROMIS-29 与健康相关的生活质量、共同决策和自我效能。主要的 实施结果包括 PRO 收集率和 PRO 仪表板使用率。 mPROVE 的成功将展示 PRO 干预和实施策略，服务于多元化 人群，可以推广到非传统 PRO，包括新颖的视觉 PRO，并满足 患者和提供者都使用 PRO 来护理患有多种慢性病的患者。