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：以高水平的承诺和信任为特征的患者支持者关系是 提供高质量护理以改善高血压（HTN）相关的结果。不幸的是，健康 差异人群最不可能在患者提供的关系中，其特征是高水平 承诺和信任，导致情感，行为和身体状况的结果，包括 互动期间的动画，药物不遵守和血压（BP）控制不佳。 Covid-19不仅强调了这些社会不平等，而且导致我们的卫生系统发生了迅速的变化 - 从 主要是远程医疗访问的人。远程医疗在改善临床方面表现出巨大的希望 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 可以通过改善对护理团队的机会来加强这些关系，但它的技术和 人际关系的缺点可能会减少承诺和信任。为了解决这些差距，该提议将利用 我们的NIMHD资助的R01建立的基础设施，该基础设施将支持10个初级保健诊所 综合技术的团队护理（此处称为ALTA），以改善药物依从性和BP 控制健康差异人群。 Alta通过机会增强了标准的面对面和远程医疗访问 对于患者和提供者，通过电子健康记录（EHR）和患者通过安全消息交往进行互动 门户。虽然Alta的中心前提是它将建立诊所的能力，以提供公平，高质量的护理 对于健康差异人群，它并非旨在评估医疗技术对患者的影响 - 提供者关系。在多级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链接到严格评估Alta的多层次影响 关于关系承诺（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例不受控制的HTN患者中的结果（第三级结果）（AIMS 1 和2）。我们的评估策略将结合患者提供者的认知，情感和行为度量 关系和患者的结果，以创建多方面的观点 当引入Alta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，状态焦虑症 库存）将通过对录音互动的自动文本分析和使用安全消息传递的使用 自然语言处理技术，以及EHR提取的有关诊所和家庭BP读数的数据以及 药物依从性（即药房记录）。 AIM 3将探索潜在的上下文因素（例如，权益；数字 扫盲；沟通方式）影响Alta与人际关系之间的关系 使用自我报告和EHR衍生的措施进行患者级别的结果。 AIM 4将使用以人为本的设计 系统地收集诊所利益相关者的反馈，以确定有效的最佳实践 技术知识的患者支持者的关系。