Enhancing patient activation in diabetes care using social and goal-based comparisons

 描述（由申请人提供）：在美国，糖尿病是肾衰竭、非创伤性下肢截肢和新失明病例的主要原因，也是心脏病和中风的主要原因。此外，糖尿病造成巨大的经济损失，每年的医疗支出高达1160亿美元。满足国家护理质量标准（例如，美国糖尿病协会护理标准）减少并发症。尽管有证据支持这些指南的重要性，但许多患者的糖尿病健康状况指标超出了这些标准。糖尿病是一种自我管理的疾病，需要患者参与计划和治疗。患者激活（即，采取行动管理个人健康和医疗保健的意愿和能力）对于实现符合国家护理质量标准并与较低成本相关的糖尿病管理至关重要。虽然越来越多的干预研究旨在增加患者的激活，但存在许多限制和差距。研究基于网络的干预措施的影响已经显示出希望，但其有效性的证据是有限的，特别是需要对照试验来确定有效的，可持续的和可扩展的策略，以增加患者的激活，并帮助患者有效地管理他们的糖尿病。为了更积极地让患者参与他们的护理，许多医疗保健组织已经开始通过患者门户网站向患者提供对实验室检测结果、药物列表和访问摘要的常规访问，有些甚至提供对病历中的笔记和其他文档的不受约束的访问。然而，仅仅了解一个人的实际和目标健康结果（如HgbA 1C值）不足以增加改善患者糖尿病自我管理所需的信心和动力，向患者提供信息的策略必须与其他行为策略相结合，以激励和帮助患者有效地管理他们的糖尿病。基于社会和目标的比较的力量（即，将自己的地位与他人的地位以及目标地位进行比较）来影响行为在各种环境中都有很好的记录。尽管有证据表明，社会比较信息增加了动机，是中央的病人的经验，它一直没有得到充分利用，以激励和维持健康的行为，糖尿病和其他慢性疾病的患者。该提案描述了一个职业发展计划，使我能够获得糖尿病患者行为科学和质量改进研究方面的专业知识，为患者开发一个新的糖尿病仪表板，其中包含有关其糖尿病健康状况的社会和基于目标的比较信息，并学习有价值的健康信息技术和研究方法，用于未来的实施研究。研究的具体目的是（1）评估患者对接受有关其糖尿病健康状况的信息的态度、感知和反应（例如，HgbA 1C，糖尿病视网膜病变筛查状态）相对于国家护理质量标准（即，基于目标的信息）以及同一医疗实践中的患者同伴的糖尿病健康状况（即，社会比较信息），（2）为患者开发一个有效的糖尿病仪表板，以说明他们的糖尿病健康状况相对于国家护理质量标准以及同一医疗实践中患者同行的糖尿病健康状况的测量，以及（3）对目标2中开发的糖尿病仪表板进行试点，集群随机对照试验（RCT）。职业发展计划包括：（a）行为科学，健康信息技术和干预研究的高级课程，（B）参加地方/国家会议，（c）多学科指导的研究经验，以及（d）高度支持的研究环境。该环境包括NIH-NIDDK资助的糖尿病翻译研究中心，杰出的生物医学信息学系，NIH资助的临床和转化科学奖，以及国际公认的行为科学，糖尿病护理和质量改进专家的指导。总的来说，这个职业发展奖将推动我在糖尿病相关行为和质量研究方面的职业发展。此外，该奖项还将为指导翻译研究/R 01申请提供关键支持。未来的研究将（a）在大型RCT中评估仪表板对患者激活以及认知、行为和临床结局的影响，（B）将仪表板纳入患者门户网站并评估用户体验，以及（c）确定对患者的财务激励是否上级仪表板中包含的糖尿病健康状况指标的目标状态。

 DESCRIPTION (provided by applicant): In the United States, diabetes is the leading cause of kidney failure, non-traumatic lower limb amputations, and new cases of blindness, and a major cause of heart disease and stroke. In addition, diabetes takes a large financial toll resulting in $116 billion in medical expenditures annually. Meeting target health outcomes (such as HgbA1C values) set by national quality of care standards (e.g., American Diabetes Association Standards of Care) reduces complications. Despite the evidence supporting the importance of these guidelines, many patients have measures of diabetes health status that fall outside of these standards. Diabetes is a self-managed condition that requires patient involvement in planning and treatment. Patient activation (i.e., willingness and ability to take action to manage one's health and healthcare) is essential to achieving diabetes management that meets national quality of care standards and is associated with lower costs. While a growing number of intervention studies aim to increase patient activation, many limitations and gaps exist. Studies looking at the impact of web-based interventions have shown promise, but evidence of their efficacy is limited and controlled trials, in particular, are needed to identify effective, sustainble, and scalable strategies to increase patient activation and assist patients in effectively managing their diabetes. In hopes of more actively involving patients in their care, many healthcare organizations have begun to routinely provide patients access to laboratory test results, medication lists, and visit summaries through patient portals, some even provide unfettered access to the notes and other documents in the medical record. However, knowledge of one's actual and target health outcomes (such as HgbA1C values) alone has been insufficient in increasing the confidence and motivation necessary to improve patients' diabetes self- management, and strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes. The power of social and goal-based comparisons (i.e., comparisons of one's own status to the status of others as well as goal status) to influence behavior is well documented in a variety of settings. Despite evidence that social comparison information increases motivation and is central to the patient experience, it has been underutilized to motivate and maintain healthy behaviors in patients with diabetes and other chronic medical conditions. This proposal describes a career development plan that enables me to gain expertise in behavioral science and quality improvement research among patients with diabetes, develop a novel diabetes dashboard for patients that contains social and goal-based comparison information about their diabetes health status, and learn valuable health information technology and research methodology for future implementation studies. The Specific Aims of the research are (1) Assess patients' attitudes, perceptions, and reactions to receiving information about their diabetes health status (e.g., HgbA1C, diabetic retinopathy screening status) relative to both national quality of care standards (i.e., goal-based information) as well as the diabetes health status of patient peers within the same medical practice (i.e., social comparison information), (2) Develop an effective diabetes dashboard for patients to illustrate measures of their diabetes health status relative to both national quality of care standards as well as the diabetes health status of patient peers within the same medical practice, and (3) Conduct a pilot, cluster randomized controlled trial (RCT) of the diabetes dashboard developed in Aim 2. The career development plan integrates: (a) advanced coursework in behavioral science, health information technology, and intervention research, (b) participation in local/national meetings, (c) a multidisciplinary mentored research experience, and (d) a highly supportive research environment. This environment includes an NIH-NIDDK funded Center for Diabetes Translation Research, a distinguished Department of Biomedical Informatics, an NIH funded Clinical and Translational Science Award, and mentorship from internationally recognized experts in behavioral science, diabetes care, and quality improvement. Overall, this career development award will advance my career in diabetes-related behavioral and quality research. In addition, the award will provide critical support to guide translational studies/R01 applications. Future studies will (a) assess the impact of the dashboard on patient activation and cognitive, behavioral, and clinical outcomes in large RCT, (b) incorporate the dashboard into a patient portal and assess the user experience, and (c) determine whether financial incentives to patients for achieving or maintaining goal status on measures of diabetes health status contained in the dashboard is superior to the dashboard alone.