Expanding Patient Engagement in Diabetes Care: Patient Portal Innovation

扩大患者对糖尿病护理的参与：患者门户创新

• 批准号: 10249951
• 负责人: William Martinez
• 金额: $ 65.16万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10249951
• 关键词: Address; Adopted; American; Attitude; Awareness; Blindness; Cardiovascular Diseases; Caring; Chronic; Clinical; Clinical Services; Data; Development; Diabetes Mellitus; Disease; Education; Electronic Health Record; Eye diseases; Feedback; Health Services; Health Services Accessibility; Health Status; Infrastructure; Intervention; Interview; Kidney Diseases; Medical Care Team; Methodology; Monitor; Notification; Ophthalmic examination and evaluation; Outcome; Patient Care; Patients; Physicians; Preventive Health Services; Preventive service; Primary Care Physician; Randomized Controlled Trials; Research; Schedule; Self Management; Services; Surveys; System; Technology; Testing; Time; Translational Research; Vaccines; Visit; Workload; colon cancer screening; cost; dashboard; design; diabetic; evidence base; evidence based guidelines; experience; health data; health information technology; health literacy; improved; innovation; literacy; novel; patient engagement; patient portal; prevent; public health relevance; service intervention; usability; user centered design

Project Summary/Abstract Evidence-based diabetes monitoring & preventative services can prevent or delay many costly and highly morbid disease-related complications, yet many patients do not receive all clinically-meaningful, evidence- based services. For example, while detecting and treating early diabetic eye disease can reduce the development of severe vision loss by an estimated 60%, approximately 40% of Americans with diabetes do not receive an annual eye exam. Prior research has demonstrated numerous barriers to the completion of evidence-based diabetes monitoring & preventative services including patient factors (eg, lack of awareness and limited health literacy) and clinician/system factors (eg, limited physician time and patient support between visits). Attempts to increase diabetes monitoring & preventative services have had only modest results. To achieve optimal rates of these services, an intervention is urgently needed that improves clinical efficiency by decreasing clinician workload, is appropriate for patients with varying levels of health literacy, and is highly scalable and sustainable. By providing an engaging and convenient means to track and visualize health data, obtain education and guidance, receive notifications, and connect patients and doctors, patient portals offer a promising platform to enhance access to health services while overcoming the limitations of costly and difficult to scale face-to-face interventions. Our research team previously applied user-centered Design Sprint methodology to develop patient portal features and functionality that were engaging and satisfying for a diverse group of patients with diabetes to use and provided users with a better understanding of their diabetes health data (eg, A1C). Feedback from users indicated a desire to self-order and self-schedule services when they become due. Using a similar approach and with strong institutional endorsement, we will design, usability test, and evaluate a novel patient portal intervention to: (a) notify patients when selected, clinically-meaningful, evidence-based diabetes monitoring & preventative services (eg, annual eye exam) become due and provide reminders for timely completion, (b) promote understanding of the importance of these services through literacy sensitive content, and (c) allow patients, when due by evidence-based guidelines, to ‘self-order’ (requires primary care physician (PCP) single-click co-signature) lab tests (eg, A1C) and vaccines prior to doctor’s visits and self-schedule clinical services (eg, eye exam). Specifically, we aim to: (1) apply Design Sprint methodology and usability testing to design and test a patient portal intervention (described above) that can overcome patient and clinician/system barriers to completing evidence-based, clinically meaningful, diabetes monitoring & preventative services among a diverse group of patients, (2) evaluate the effect of the patient portal intervention developed in Aim 1 on the completion of those services in a pragmatic, cluster randomized controlled trial, and (3) assess PCP’s attitudes and experiences, through surveys and interviews, regarding the acceptability and usefulness of the intervention and its impact on clinical efficiency.

项目总结/摘要 基于证据的糖尿病监测和预防服务可以预防或延迟许多昂贵和高风险的疾病。 病态疾病相关并发症，但许多患者没有接受所有临床意义，证据， 基于服务。例如，虽然检测和治疗早期糖尿病性眼病可以减少糖尿病性眼病的发生， 发展严重的视力丧失估计60%，约40%的美国糖尿病患者没有 接受年度眼科检查。之前的研究表明，完成眼科检查存在许多障碍。 基于证据的糖尿病监测和预防服务，包括患者因素（例如，缺乏意识 和有限的健康素养）和临床医生/系统因素（例如，有限的医生时间和患者支持， 访问）。增加糖尿病监测和预防服务的努力收效甚微。到 为了实现这些服务的最佳比率，迫切需要通过以下措施提高临床效率的干预措施： 减少临床医生的工作量，适用于不同健康素养水平的患者， 可扩展和可持续。通过提供一种吸引人的和方便的手段来跟踪和可视化健康数据， 获得教育和指导，接收通知，并连接患者和医生，患者门户网站提供了一个 一个有前途的平台，以改善获得保健服务的机会，同时克服昂贵和困难的限制， to scale规模of face面对to face面对面interventions干预.我们的研究团队之前应用了以用户为中心的Design Sprint 开发患者门户功能和功能的方法，这些功能和功能吸引并满足各种 一组糖尿病患者使用，并为用户提供了更好地了解他们的糖尿病健康 数据（例如A1 C）。来自用户的反馈表明，当他们 成为应有的。使用类似的方法，并与强大的机构认可，我们将设计，可用性测试， 并评估一种新的患者入口介入，以：（a）在选择时通知患者，具有临床意义， 基于证据的糖尿病监测和预防服务（例如，每年的眼科检查）成为应有的，并提供 提醒及时完成，（B）通过以下方式促进对这些服务重要性的理解 识字敏感的内容，和（c）允许病人，当根据循证指南，“自我订购” （需要初级保健医生（PCP）单击共同签名）实验室检测（例如A1 C）和疫苗， 医生的访问和自我安排的临床服务（如眼科检查）。具体而言，我们的目标是：（1）应用设计 Sprint方法和可用性测试，用于设计和测试患者门户干预（如上所述）， 可以克服患者和临床医生/系统障碍，完成基于证据的，有临床意义的， 糖尿病监测和预防服务的不同群体的患者，（2）评估的效果， 在目标1中开发的患者门户干预，在务实的集群中完成这些服务 随机对照试验，和（3）评估PCP的态度和经验，通过调查和访谈， 关于干预的可接受性和有用性及其对临床效率的影响。