Using Virtual Environments to Improve Health and Compliance in Diabetes

使用虚拟环境改善糖尿病患者的健康状况和依从性

• 批准号: 7821061
• 负责人: Charles Scott Rigby
• 金额: $ 95.97万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7821061
• 关键词: Address; Adopted; Adult; American; Area; Behavior; Body Weight decreased; Cardiovascular Diseases; Caring; Cessation of life; Clinical; Computers; Counseling; Data; Development; Devices; Diabetes Mellitus; Education; Effectiveness; Electronics; Employee; Employee Health; Environment; Goals; Health; Health Promotion; Healthcare; Individual; Insurance Carriers; Internet; Intervention; Medical; Metabolic; Methods; Monitor; Motivation; New York; Non-Insulin-Dependent Diabetes Mellitus; Nurse Practitioners; Nurses; Nutritionist; Office Visits; Overweight; Patients; Physical activity; Physician Assistants; Pilot Projects; Primary Health Care; Professional counselor; Public Health; Randomized; Recruitment Activity; Regimen; Research; Safety; System; Testing; Time; Translating; Translations; Visit; Weight; Weight Gain; base; comparative effectiveness; compliance behavior; cost; diabetic; diabetic patient; effective intervention; effectiveness research; heart disease risk; high risk; improved; intervention program; lifestyle intervention; nutrition; patient population; programs; treatment as usual; treatment planning; virtual; virtual reality

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05): Comparative Effectiveness Research and Specific Challenge topic 05-LM-104* Value of "Virtual Reality" Interaction in Improving Compliance with Diabetic Regimen. Diabetes has become a serious public health problem. According to data from the American Diabetes Association, 21 million Americans have diabetes, and 95% of those cases are Type 2 (ADA Standards of Medical Care in Diabetes, 2008). The Look AHEAD Program (Look AHEAD, 2007) is one intervention that has proven efficacious in reducing weight, increasing physical activity, and improving metabolic factors in adults with type-2 diabetes. However, the Look AHEAD Program has not yet been effectively translated into care. The major barrier to translation for programs like Look AHEAD is the extended clinical contact required for these interventions to be efficacious. Intensive interventions often are not feasible within primary care due to lack of time and constraints on office systems, and other health-promotion programs (e.g., employee wellness) often do not adopt such programs because of their up-front costs. Thus, there is a clear challenge to create new methods for delivering effective interventions to the population of patients and employees with diabetes who are at high risk for cardiovascular disease and death. The proposed research seeks to translate the Look AHEAD (LA) intensive lifestyle intervention into employee health programs through the development of a Virtual Look AHEAD Program (VLAP). The VLAP will (1) interact with the diabetic patient to create a preliminary treatment plan that is then approved in a visit with their study practitioner, (2) provide ongoing LA-based nutrition and physical activity counseling that is available on demand, 24/7 from any Internet-connected computer and browser-capable mobile device, and (3) collect data on patient adherence, health, and motivation. Because the VLAP will be developed to be available through Internet devices, customized treatment plans will be monitored for effectiveness and safety in a monthly office visit with the study employee health care practitioner (e.g., nutritionist, nurse, nurse practitioner, or physician assistant). The proposed pilot study will test the initial use of the VLAP in a small randomized comparative effectiveness pilot in employees recruited from two large self-insured employers in Rochester, New York comparing Group 1 VLAP + study practitioner (N=35) vs. Group 2 Standard Diabetes Support and Education + study practitioner (N=35) in reducing weight to LA goal of 7% loss over 6 months. This project will create an electronic physical activity counselor, and nutritionist that will discuss healthy behaviors (physical activity, nutrition) with employees with diabetes and help employees build a plan for weight loss and increased physical activity to reduce their risk for heart disease.

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）：比较有效性研究和特定挑战主题05-LM-104*“虚拟现实”交互在提高糖尿病治疗方案依从性中的价值。糖尿病已成为一个严重的公共卫生问题。根据美国糖尿病协会的数据，2100万美国人患有糖尿病，其中95%为2型糖尿病（ADA糖尿病医疗护理标准，2008）。展望未来计划（展望未来，2007年）是一种干预措施，已被证明有效地减轻体重，增加体力活动，并改善2型糖尿病成人的代谢因素。然而，展望未来方案尚未有效地转化为护理。像Look AHEAD这样的项目翻译的主要障碍是这些干预措施有效所需的长期临床接触。由于缺乏时间和办公系统的限制，强化干预在初级保健中往往不可行，其他健康促进计划（例如，员工健康）往往不采用这种方案，因为他们的前期成本。因此，有一个明确的挑战，创造新的方法，提供有效的干预措施，糖尿病患者和员工的人口谁是高风险的心血管疾病和死亡。拟议的研究旨在通过虚拟展望未来计划（Virtual Look AHEAD Program，简称VRESS）的发展，将展望未来（Look AHEAD，简称LA）强化生活方式干预转化为员工健康计划。VEGFR 2将（1）与糖尿病患者进行互动，以创建初步治疗计划，然后在其研究医生的访视中批准该计划，（2）通过任何联网计算机和支持浏览器的移动终端提供持续的基于LA的营养和体力活动咨询（按需提供，24/7），以及（3）收集患者依从性、健康和动机的数据。由于VEGFR 2将开发为可通过互联网设备获得，因此将在每月一次的办公室访视中与研究员工医疗保健从业者（例如，营养学家、护士、执业护士或医师助理）。拟定的初步研究将在从罗切斯特（纽约）两家大型自保雇主招募的员工中进行的小型随机化比较有效性试验中测试VELCADE的初始使用，比较第1组VELCADE+研究从业者（N=35）与第2组标准糖尿病支持和教育+研究从业者（N=35）在6个月内将体重减轻至LA目标7%的情况。该项目将创建一个电子体育活动顾问和营养师，与糖尿病员工讨论健康行为（体育活动，营养），并帮助员工制定减肥计划和增加体育活动，以降低心脏病风险。