Implementation Outcomes of a Health IT Program For Vulnerable Diabetes Patients

针对弱势糖尿病患者的健康 IT 计划的实施结果

基本信息

项目摘要

DESCRIPTION (provided by applicant): Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We propose to evaluate the fidelity of implementation of an innovative health information technology (Health IT) intervention for patients with chronic disease, the Automated Telephone Support Program (ATSM) developed to reach vulnerable populations with diabetes. We have developed and studied ATSM in efficacy and effectiveness trials, finding ATSM is associated with improvements in multiple diabetes-related outcomes. ATSM has received national attention, and is aligned with the national health care reform policy focus on determining how best to deploy health IT to deliver effective health care at low cost to large sectors of the US population. Based on the growing interest, it is critical to examine factors associated with ATSM implementation that may impact its wider adoption. ATSM is a complex intervention that employs phone technology to provide patient surveillance and education and to prioritize further telephone care management efforts for those most in need. ATSM innovation relates to its: (1) integration of electronic information into ongoing clinical care, to improve quality and efficiency of care delivery; and (2) effective health communication tailoring, by care managers over the telephone, for the provision of literacy or language-tailored support counseling. We have provided ATSM in a 'real world' implementation study, with AHRQ funding, in partnership with a regional health plan, the San Francisco Health Plan (SFHP). We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase its adoption. Specifically, we will use a modified Conceptual Framework for Evaluating Implementation Fidelity to organize essential ATSM delivery components. We will use this framework to structure a detailed data-based assessment of fidelity measures (e.g. frequency, content, and duration of ATSM delivery), and measures related to proposed moderating factors to ATSM delivery (e.g. representativeness of participants vs. non- participants, and quality of care management calls). We will work with SFHP to analyze the extensive data collected for the ATSM program, and to develop a User Guide that may inform other organizations considering scaling up similar health IT interventions. There is scant literature on how to adapt complex health IT interventions, such as ATSM, to local health systems needs. Examining the fidelity of implementation of such a program, describing adaptations that were made to improve adoption, and examining how adaptations and moderators will provide relevant necessary information. These findings can move forward the field of diabetes care, provide timely information on processes of adoption critical to implementation planning, and serve as a model for evaluating other complex health IT interventions. This R03 serves as an essential component to developing an evidence base to inform the scaling up health IT innovations such as ATSM. PUBLIC HEALTH RELEVANCE: Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We have developed and found successful in efficacy studies, a health IT innovation that is tailored to patient language and literacy needs, and are completing a study of its effectiveness in a 'real world' translational research trial, with a local Medicaid managed care plan. We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase adoption. This information can inform efforts underway in national health reform, to scale up health IT interventions to off-set growing chronic disease care costs.
描述(由申请人提供):糖尿病是一个主要的公共卫生问题,不成比例地影响弱势群体,包括种族和少数民族,社会经济地位较低的人和健康素养低的人。我们建议评估实施创新的健康信息技术(健康IT)干预慢性病患者,自动电话支持计划(ATSM),以达到糖尿病弱势群体的保真度。我们在疗效和有效性试验中开发和研究了ATSM,发现ATSM与多种糖尿病相关结局的改善相关。ATSM已经得到了全国的关注,并与国家医疗保健改革政策的重点是确定如何最好地部署卫生信息技术,以提供有效的医疗保健,以低成本的大部分美国人口。基于日益增长的兴趣,关键是要检查与ATSM实施相关的因素,这些因素可能会影响其更广泛的采用。ATSM是一种复杂的干预措施,它采用电话技术来提供患者监测和教育,并优先考虑为最需要的人提供进一步的电话护理管理工作。ATSM创新涉及:(1)将电子信息整合到正在进行的临床护理中,以提高护理提供的质量和效率;(2)由护理经理通过电话进行有效的健康沟通定制,以提供识字或语言定制的支持咨询。我们已经提供了ATSM在一个“真实的世界”的实施研究,与AHRQ的资金,在合作伙伴关系与区域健康计划,弗朗西斯科健康计划(SFHP)。我们建议在本R 03中检查干预措施实施的保真度,并检查为增加其采用而进行的调整。具体来说,我们将使用一个修改后的概念框架来评估实现保真度,以组织基本的ATSM交付组件。我们将使用该框架构建一个详细的基于数据的忠诚度评估指标(例如ATSM交付的频率、内容和持续时间),以及与ATSM交付的拟议调节因素相关的指标(例如参与者与非参与者的代表性,以及护理管理呼叫的质量)。我们将与SFHP合作,分析为ATSM计划收集的大量数据,并制定一份用户指南,为其他考虑扩大类似医疗IT干预的组织提供信息。关于如何调整复杂的卫生IT干预措施(例如ATSM)以适应当地卫生系统需求的文献很少。检查这样一个计划的实施的保真度,描述为提高采用率而进行的调整,并检查调整和主持人将如何提供相关的必要信息。这些发现可以推动糖尿病护理领域的发展,及时提供对实施计划至关重要的采用过程的信息,并作为评估其他复杂的健康信息技术干预措施的模型。R 03是开发证据库的重要组成部分,为扩大ATSM等卫生IT创新提供信息。 公共卫生相关性:糖尿病是一个主要的公共卫生问题,对弱势群体的影响尤为严重,包括少数种族和少数民族、社会经济地位较低的人和健康素养低的人。我们已经开发并发现了成功的疗效研究,这是一种针对患者语言和识字需求的健康IT创新,并正在完成一项关于其在“真实的世界”转化研究试验中的有效性的研究,并采用当地的医疗补助管理护理计划。我们建议在本R 03中检查干预措施实施的保真度,并检查为增加采用而进行的调整。这些信息可以为正在进行的国家卫生改革提供信息,以扩大卫生信息技术干预,抵消不断增长的慢性病护理费用。

项目成果

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MARGARET Anne HANDLEY其他文献

MARGARET Anne HANDLEY的其他文献

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{{ truncateString('MARGARET Anne HANDLEY', 18)}}的其他基金

Empowering Formerly Homeless Older Adults to Engage in Advance Care Planning in Permanent Supportive Housing (ACP-PSH): An RCT
帮助以前无家可归的老年人参与永久支持性住房中的预先护理计划 (ACP-PSH):一项随机对照试验
  • 批准号:
    10639204
  • 财政年份:
    2023
  • 资助金额:
    $ 10万
  • 项目类别:
Adapting an Automated Telephone Support Program to Prevent Type 2 Diabetes
采用自动电话支持计划来预防 2 型糖尿病
  • 批准号:
    8552087
  • 财政年份:
    2013
  • 资助金额:
    $ 10万
  • 项目类别:
Adapting an Automated Telephone Support Program to Prevent Type 2 Diabetes
采用自动电话支持计划来预防 2 型糖尿病
  • 批准号:
    8352799
  • 财政年份:
    2012
  • 资助金额:
    $ 10万
  • 项目类别:
Adapting an Automated Telephone Support Program to Prevent Type 2 Diabetes
采用自动电话支持计划来预防 2 型糖尿病
  • 批准号:
    9032360
  • 财政年份:
  • 资助金额:
    $ 10万
  • 项目类别:
Adapting an Automated Telephone Support Program to Prevent Type 2 Diabetes
采用自动电话支持计划来预防 2 型糖尿病
  • 批准号:
    8625197
  • 财政年份:
  • 资助金额:
    $ 10万
  • 项目类别:

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