Leveraging Heath Information Technology to Improve Post-Discharge Management for Patients with Heart Failure

利用健康信息技术改善心力衰竭患者的出院后管理

• 批准号: 10592045
• 负责人: Eun Ji Kim
• 金额: $ 19.17万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592045
• 关键词: Address; Applications Grants; Behavior Therapy; Behavioral Sciences; Cardiovascular system; Caring; Cellular Phone; Clinical; Clinical Investigator; Computers; Effectiveness; Failure; Feedback; Focus Groups; Foundations; Goals; Health; Health system; Heart failure; Homelessness; Hospitalization; Hospitals; Individual; Intervention; K-Series Research Career Programs; Knowledge; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Monitor; Nurses; Outcome; Patient Care; Patient Triage; Patients; Perception; Physicians; Positioning Attribute; Randomized; Randomized, Controlled Trials; Research; Research Activity; Research Personnel; Research Project Grants; Research Project Summaries; Resources; Risk; Sample Size; Services; Technology; Testing; Text; Text Messaging; Time; Training; Training Activity; Transcript; Use Effectiveness; Work; automated text message; career; experience; group intervention; health care service utilization; health information technology; health literacy; hospital readmission; implementation science; improved; insight; low health literacy; patient handout; patient navigator; poor health outcome; posthospitalization care; power analysis; prototype; screening program; skills; social; social health determinants; text messaging intervention; theories; tool; trial design; uptake; usability; usual care arm

Project Summary My long-term career goal is to become a clinician investigator, who uses health information technology (IT) to improve cardiovascular outcomes among patients with social needs. The research goal of this application is to use health IT to reduce preventable readmissions for heart failure (HF) among patients with low health literacy with the incorporation of behavioral science and usability testing. Social determinants of health (SDH) account for 80% of health outcomes, and social needs are associated with poor health outcomes, including 30-day readmissions. Addressing individuals’ social needs has been associated with improved clinical outcomes, but may take a prolonged time to effectively reduce 30-day readmissions. Health literacy, which measures a patient’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, is associated with patients’ health outcomes. Low health literacy is common among patients with HF, and leads to poor management of HF. Extant interventions, such as patient navigators and handouts, have been utilized successfully to improve medical care for patients with low health literacy, but they are episodic and resource-intensive. The use of health IT tools, such as a personalized, automated text-message-based application, can be utilized for post-hospitalization care. Our preliminary study indicates that patients with HF who use this application had reduced 30-day readmissions, compared to patients with HF who did not use the application. However, the number of patients with HF using the application has been limited, due to low uptake and high attrition rate. The overall objective of the proposed research project is to incorporate nudges, and address barriers to improve patients’ use of the application, and conduct a pilot randomized controlled trial (RCT) to evaluate the application’s use in reducing 30-day readmissions. We will conduct qualitative work to gain insights into how to adapt an extant text messaging intervention to improve its use among patients with low health literacy (Aim 1), conduct usability testing and iterative revision of the application (Aim 2), and conduct a pilot RCT to evaluate the acceptability, feasibility, and preliminary efficacy of using behavioral interventions to increase the application use for patients with HF post-discharge (Aim 3). The training from this mentored career development award will provide skills in four domains: 1) behavioral science; 2) implementation science; 3) health literacy; and 4) RCT design and conduct. The proposed research activities, and the training and mentoring plans will provide the foundation for my career as an independent clinician investigator.

项目摘要 我的长期职业目标是成为一名临床研究员，他使用健康信息技术（IT） 改善有社会需求患者的心血管结局。本申请的研究目标是 使用健康信息技术减少健康素养低的患者因心力衰竭（HF）而可预防的再入院 结合了行为科学和可用性测试。健康的社会决定因素账户 80%的健康结果，社会需求与不良的健康结果有关，包括30天的 再入院满足个人的社会需求与改善临床结果有关，但 可能需要很长时间才能有效减少30天的再入院率。健康素养，衡量一个 患者查找、理解和使用信息和服务以告知健康相关决策的能力， 为自己和他人采取的行动，与患者的健康结果有关。健康素养低是普遍现象 在HF患者中，并导致HF管理不善。现有的干预措施，如患者 导航器和讲义，已成功地用于改善医疗保健的病人低健康 扫盲，但它们是偶发的和资源密集型的。使用卫生信息技术工具，如个性化的， 自动化的基于文本消息的应用程序，可用于住院后护理。我们的初步研究 表明使用该应用程序的HF患者减少了30天的再入院率， 未使用该应用程序的心力衰竭患者。然而，使用 由于低吸收率和高损耗率，应用受到限制。建议的总体目标 研究项目是结合推动，并解决障碍，以改善患者的应用程序的使用， 进行一项试点随机对照试验（RCT），以评估该应用程序在减少30天 再入院我们将进行定性工作，以深入了解如何适应现有的短信 采取干预措施，以改善其在健康素养低的患者中的使用（目标1），进行可用性测试， 迭代修订申请（目标2），并进行试点RCT，以评估可接受性，可行性， 以及使用行为干预增加HF患者应用的初步疗效 出院后（目标3）。从这个指导职业发展奖的培训将提供四个技能 领域：1）行为科学; 2）实施科学; 3）健康素养; 4）RCT设计和实施。 拟议的研究活动，以及培训和指导计划将为我的研究奠定基础。 作为一名独立的临床研究者。