A Mobile Relational Agent to Enhance Atrial Fibrillation Self-care

增强心房颤动自我护理的移动关系代理

• 批准号: 10610784
• 负责人: Jared W. Magnani
• 金额: $ 21.16万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-27 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10610784
• 关键词: Address; Adherence; Advisory Committees; Anticoagulants; Anticoagulation; Atrial Fibrillation; Benchmarking; Black race; Cardiovascular Diseases; Cardiovascular system; Caring; Cellular Phone; Chronic; Chronic Disease; Clinic; Complement; Complex; Computer Literacy; Computers; Cues; Data; Disease Outcome; Education; Educational Curriculum; Electronic Health Record; Emergency Situation; Facial Expression; Gestures; Guidelines; Hand; Health; Health Educators; Health Promotion; Health Status; Health behavior outcomes; Health education; Health system; Heart Rate; Heart failure; Hospitalization; Incidence; Income; Individual; Information Systems; International; Intervention; Interview; Low income; Measurement; Measures; Medical Care Costs; Medical center; Modification; Monitor; Morbidity - disease rate; Myocardial Infarction; Outcome; Outcome Measure; Participant; Patient Care; Patient Outcomes Assessments; Patient Self-Report; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Prevalence; Preventive treatment; Problem Solving; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Research; Resources; Self Care; Self Efficacy; Speech; Stroke; Stroke prevention; Symptoms; System; Terminology; Testing; Universities; Visit; Voice; arm; base; clinical infrastructure; cohort; complex chronic conditions; cost; diaries; disabling symptom; efficacy evaluation; efficacy testing; ethnic minority; experience; gaze; health application; health care service utilization; health literacy; health related quality of life; heart rhythm; high risk; improved; innovation; intervention effect; intervention participants; mHealth; medical specialties; member; mortality; novel; novel strategies; optimal treatments; patient oriented; primary outcome; programs; racial and ethnic; recruit; secondary outcome; skills; social; social determinants; social factors; social health determinants; socioeconomics; standard care; stroke risk; success; symptom treatment

PROJECT SUMMARY Atrial fibrillation (AF) is a common, morbid condition. Symptoms, complex management, and significant adversity contribute to poor health-related quality of life (HRQoL). Social determinants of health exacerbate morbidity in AF, and limited health literacy compounds the poor patient experience of AF. We propose a single- center parallel group randomized clinical trial to test the efficacy of an embodied conversational agent (ECA) to improve patient-centered care in AF. The ECA is a computer character that simulates face-to-face conversation using voice, hand gesture, and gaze cues to provide education, monitoring and problem-solving. We have used the ECA in multiple health contexts for self-care and demonstrated its success to improve health behaviors and outcomes in individuals with limited computer and health literacy. Here we propose to expand our successful 30-day pilot (n=31) of the ECA and the AliveCor Kardia smartphone heart rate and rhythm monitor in order to evaluate the effect of a 4-month self-care curriculum and assess its 12-month sustainability. We will further test the integration of ECA/Kardia results in the electronic health record (EHR) and monitor alerts and resulting modifications to care. We will randomize 240 patients with AF who are receiving anticoagulation to either (1) the ECA/Kardia intervention, provided by smartphone, and accompanying EHR alerts, or (2) the control, consisting of an AF educational session, diary for recording symptoms and adherence, and a smartphone with a general health application for self-care (WebMD). Our trial will leverage the clinical infrastructure of the University of Pittsburgh Medical Center (UPMC) by recruiting at 8 UPMC clinics that share a common electronic health record. We will focus recruitment on individuals with limited socioeconomic resources, low health literacy, or racial/ethnic minorities. Our aims are: (1) To examine the effect of the ECA/Kardia intervention on patient-centered outcomes. We will evaluate HRQoL with the AF- specific AF Effect on QualiTy of life (AFEQT) measure and general HRQoL with the Patient-Reported Outcomes Measurement Information System-29 Profile at baseline, 4, and 12 months. (2) To evaluate the effect of the ECA/Kardia and EHR alert intervention on anticoagulant adherence. We will quantify adherence using medication possession ratio and pharmacy contact at 12 months, and complementary measures of self- reported non-adherence at baseline, 4, and 12 months. (3) To determine the effect of the intervention on health care utilization at 4 and 12 months using participant interview and the common EHR. Our trial will engage an 8- member patient advisory committee comprised of individuals with chronic AF to guide the intervention's cultural acceptability, recruitment, and presentation of results. Expected Results: In this project we will evaluate a scalable patient-centered intervention to improve HRQoL, improve anticoagulation adherence, and reduce health care utilization in vulnerable individuals with chronic AF. If proven successful, this intervention can be broadly disseminated to improve the care of patients with AF.

项目摘要 心房颤动（AF）是一种常见的病态疾病。症状、复杂的管理和显著的 逆境导致健康相关生活质量（HRQoL）下降。健康的社会决定因素加剧 AF的发病率，以及有限的健康素养加剧了AF患者的不良经历。我们提出了一个单一的- 中心平行组随机临床试验，以测试体现对话代理（ECA）的功效， 改善以患者为中心的AF护理。ECA是一种模拟面对面的计算机字符 使用语音、手势和凝视提示进行对话，以提供教育、监控和解决问题。 我们已经在多种健康环境中使用ECA进行自我护理，并证明其成功改善了 计算机和健康知识有限的个人的健康行为和结果。在此，我们建议 扩大我们成功的ECA和AliveCor卡尔迪亚智能手机心率的30天试点（n=31）， 节奏监测，以评估4个月的自我护理课程的效果，并评估其12个月 持续发展我们将进一步测试ECA/卡尔迪亚结果在电子健康记录（EHR）中的整合 并监测警报和由此产生的护理修改。我们将随机选择240例房颤患者， 接受抗凝治疗（1）通过智能手机提供的ECA/卡尔迪亚干预，以及 伴随EHR警报，或（2）控制，包括AF教育会话、记录日志 症状和依从性，以及具有用于自我护理的一般健康应用程序（WebMD）的智能手机。我们的试验 将利用匹兹堡大学医学中心（UPMC）的临床基础设施， UPMC诊所共享一个共同的电子健康记录。我们将重点招聘个人， 社会经济资源有限、健康素养低或种族/民族少数。我们的目标是：（1）检查 ECA/卡尔迪亚干预对以患者为中心的结局的影响。我们将使用AF评估HRQoL- 患者报告的特定AF对生活质量的影响（AFEQT）指标和一般HRQoL 结果测量信息系统-基线、4个月和12个月时的29个特征。(2)评价 ECA/卡尔迪亚和EHR警报干预对抗凝剂依从性的影响。我们将量化依从性 使用12个月时的药物拥有率和药房接触率，以及自我- 在基线、4个月和12个月时报告不依从。(3)确定干预措施对健康的影响 在4个月和12个月的护理利用率使用参与者访谈和共同的EHR。我们的审判将涉及8- 由慢性房颤患者组成的患者咨询委员会成员，指导干预的文化 结果的可接受性、招聘和展示。预期结果：在本项目中，我们将评估 可扩展的以患者为中心的干预，以改善HRQoL，提高抗凝依从性，并减少 慢性AF脆弱个体的医疗保健利用。如果证明成功，这种干预可以 广泛传播，以改善AF患者的护理。