Do no digital harm? A multilevel evaluation of technology-facilitated team care on the patient-provider relationship in health disparity populations

没有数字伤害吗？

• 批准号: 10563565
• 负责人: Antoinette M Schoenthaler
• 金额: $ 70.79万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-11 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10563565
• 关键词: Address; Adoption; Adult; Affect; Affective; Anxiety; Audiotape; Behavior; Behavioral; Black race; Blood Pressure; COVID-19; Caring; Characteristics; Clinic; Clinical Management; Cognitive; Communication; Competence; Data; Data Sources; Electronic Health Record; Equipment and supply inventories; Equity; Evaluation; Faculty; Feedback; Funding; Health; Health Services Accessibility; Health Technology; Health system; Home; Household; Hypertension; Improve Access; Individual; Inequity; Infrastructure; Insurance; Interview; Investments; Latinx; Link; Measures; Medicaid; Medical; Medicare; Methods; Modality; National Institute on Minority Health and Health Disparities; Natural Language Processing; Not Hispanic or Latino; Outcome; Patient Self-Report; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmacy facility; Physiological; Privatization; Provider; Quality of Care; Records; Research; Research Design; Risk; Secure; Site; Socioeconomic Status; Surveys; System; Techniques; Technology; Telephone; Therapeutic; Trust; Visit; Vulnerable Populations; Work; anxiety states; automated text message; behavior measurement; blood pressure control; contextual factors; digital; disorder control; ethnic minority; experience; health care quality; health disparity populations; health equity; human centered design; hypertension control; improved; literacy; long-standing disparities; medication compliance; medication nonadherence; negative affect; patient population; patient portal; primary care clinic; primary outcome; programs; racial minority; remote patient monitoring; remote visit; safety net; secondary outcome; social; telehealth; theories; tool; virtual health

Project Summary: Patient-provider relationships characterized by high levels of commitment and trust are central to delivering high quality care for improved hypertension (HTN)-related outcomes. Unfortunately, health disparity populations are least likely to be in patient-provider relationships characterized by high levels of commitment and trust leading to negative affective, behavioral and physiological patient outcomes including heightened anxiety during the interaction, medication non-adherence, and poor blood pressure (BP) control. COVID-19 not only highlighted these social inequities but also led to a rapid change of our health system – from mainly in-person to telehealth visits. While telehealth has shown great promise in improving the clinical management of HTN, its impact on patient-provider relationships is unclear. Some evidence suggests telehealth could strengthen these relationships through improved access to the care team, but its technical and interpersonal drawbacks may reduce commitment and trust. To address these gaps, this proposal will leverage the infrastructure established by our NIMHD-funded R01, which will support 10 primary care clinics in the integration of technology-facilitated team care (herein called ALTA) to improve medication adherence and BP control in health disparity populations. ALTA enhances standard in-person and telehealth visits with opportunities for patients and providers to interact via secure messaging through the electronic health record (EHR) and patient portals. While a central premise of ALTA is that it will build clinic capacity to deliver equitable, high-quality care to health disparity populations, it was not designed to evaluate the impact of healthcare technologies on patient- provider relationships. Guided by the multilevel NIMHD research framework, the proposed study will employ a mixed methods study design that links four data sources to rigorously evaluate the multilevel impacts of ALTA on relationship commitment (primary outcome), patient-provider trust (secondary outcome) and patient health outcomes (tertiary outcomes) across 10 primary care clinics and 700 patients with uncontrolled HTN (Aims 1 and 2). Our evaluation strategy will combine cognitive, affective and behavioral measures of the patient-provider relationship and patient outcomes to create a multifaceted view of how individual perceptions and actions of the partners change when ALTA is introduced. Specifically, validated self-report measures (e.g., State Anxiety Inventory) will be augmented by automated text analysis of audiotaped interactions and secure messaging using natural language processing techniques, and EHR-extracted data on clinic and home BP readings and medication adherence (i.e., pharmacy records). Aim 3 will explore potential contextual factors (e.g., equity; digital literacy; communication modality) that influence the relationship between ALTA and the interpersonal and patient-level outcomes using self-report and EHR-derived measures. Aim 4 will use the human centered design approach to systematically gather feedback from clinic stakeholders to identify best practices for effective technology-facilitated patient-provider relationships.

项目摘要：以高度承诺和信任为特征的患者-提供者关系是 是提供高质量护理以改善高血压（HTN）相关结局的核心。不幸的是，健康 差异人群最不可能处于以高水平的 承诺和信任导致消极的情感，行为和生理患者结果，包括 在互动过程中焦虑加剧，药物治疗不依从，血压（BP）控制不佳。 COVID-19不仅凸显了这些社会不平等，还导致了我们的卫生系统的迅速变化--从 主要是面对面到远程保健访问。虽然远程医疗在改善临床 HTN的管理，其对患者-提供者关系的影响尚不清楚。一些证据表明远程医疗 可以通过改善与护理团队的接触来加强这些关系，但其技术和 人际关系的缺陷可能会减少承诺和信任。为了弥补这些差距，本提案将利用 由我们的NIMHD资助的R 01建立的基础设施，将支持10个初级保健诊所， 整合技术促进的团队护理（以下称为阿尔塔），以改善药物依从性和BP 控制人群健康差距。阿尔塔通过机会加强标准的面对面和远程保健访问 患者和提供者通过电子健康记录（EHR）和患者之间的安全消息传递进行交互， 门户虽然阿尔塔的一个中心前提是，它将建立诊所能力，提供公平，高质量的护理 对于健康差距人群，它不是为了评估医疗保健技术对患者的影响， 供应商关系。在多层次NIMHD研究框架的指导下，拟议的研究将采用 混合方法研究设计，将四个数据源联系起来，以严格评估阿尔塔的多层次影响 关系承诺（主要结果），患者-提供者信任（次要结果）和患者健康 在10个初级保健诊所和700例未控制的HTN患者中的结局（三级结局）（目的1 和2）。我们的评估策略将结合联合收割机的认知，情感和行为的措施，病人提供者 关系和病人的结果，以创建一个多方面的看法，如何个人的看法和行动， 当引入阿尔塔时，合作伙伴会发生变化。具体而言，经过验证的自我报告措施（例如，状态焦虑 库存）将通过对录音互动的自动文本分析和使用 自然语言处理技术，以及从诊所和家庭BP读数中提取的EHR数据， 药物依从性（即，药房记录）。目标3将探索潜在的背景因素（例如，公平;数字 影响阿尔塔与人际关系和 使用自我报告和EHR衍生措施的患者水平结果。目标4将采用以人为本的设计 系统收集诊所利益相关者反馈的方法，以确定有效的最佳实践 技术促进的医患关系。