Web-Based Simulated Patient Interviewing for Developing MI Skills for Health Care

描述（由申请人提供）：糖尿病和心血管疾病的可改变的行为风险因素包括肥胖、缺乏体育活动、吸烟和过度饮酒，这两种疾病在人类和金钱方面都是代价最高的疾病。尽管医学界长期以来一直致力于慢性病护理模式的发展，以支持行为风险因素的改变，但一般来说，初级保健临床医生并不提供慢性病护理模式的一个关键特征：以患者为中心的行为咨询。动机访谈（MI）是一种以患者为中心的循证咨询形式，当应用于糖尿病和心血管疾病的危险因素时，可以改善患者的预后。为了支持在初级保健中传播精神病学以改变健康行为，该领域需要低成本和易于获取的方法来评估和培训以患者为中心的沟通中许多学科的从业人员。拟议的项目旨在开发一个基于计算机的系统，以支持医疗保健提供者，该系统包括医疗保健特定的心肌梗死技能评估和一套模拟患者培训案例，提供者可以使用这些案例来练习他们的心肌梗死技能。该系统将基于网络，极大地方便了访问和使用。第一阶段的目标包括开发技能评估的原型和一个交互式实践案例，对12名临床医生进行实践案例的可用性测试，并对24名初级保健提供者进行技能评估的初始心理测量特性的试点研究。在第二阶段，将开发完整的产品并在随机试验中进行评估，以建立评估的信度和效度以及培训案例的培训效果。鉴于糖尿病和心脏病带来的重大健康挑战，以及采用慢性护理和初级保健医疗家庭模式的广泛运动，我们预计对此类产品的需求将会很大。

DESCRIPTION (provided by applicant): Modifiable behavioral risk factors for diabetes and cardiovascular disease, two of the most costly diseases in both human and monetary terms, include obesity, lack of physical activity, smoking tobacco and excess alcohol consumption. Despite a longstanding movement in the medical community towards models of chronic care to support changes in behavioral risk factors, primary care clinicians, in general, do not provide a key feature in chronic care models: patient-centered behavioral counseling. Motivational Interviewing (MI), an evidence-based form of patient-centered counseling, improves patient outcomes when applied to risk factors for diabetes and cardiovascular disease. To support dissemination of MI for health behavior change in primary care, the field needs low cost and highly accessible methods to both evaluate and train practitioners of many disciplines in patient-centered communication. The proposed project aims to develop a computer-based system to support healthcare providers consisting of a health care specific MI skills assessment and a suite of simulated patient training cases that providers can use to practice their MI skills. The system will be web-based to greatly facilitate access and utility. Phase I aims include developing a prototype of the skill assessment and one interactive practice case, conducting usability testing of the practice case with 12 clinicians and conducting a pilot study of the initial psychometric properties of the skill assessment with 24 primary care providers. In Phase II, the complete product will be developed and evaluated in a randomized trial to establish reliability and validity of the assessment and training effectiveness of the training cases. Given the crucial health challenge presented by diabetes and heart disease, as well as wide movement to adopt chronic care and primary care medical home models, we expect demand for such a product to be large. PUBLIC HEALTH RELEVANCE: This project will develop online training support resources for healthcare providers learning motivational interviewing. Chronic diseases such as diabetes have reached epidemic proportions in the US but are largely preventable and treatable with health behavior changes. With better access to training in motivational interviewing, healthcare providers may be better able to help patients make difficult lifestyle changes.