Optimizing Veterans Use of eHealth Technologies

描述(由申请人提供)： 职业目标：岛田芳妮，博士，2005年在哈佛大学获得博士学位，随后来到贝德福德VAMC参加HSR&D博士后健康服务研究奖学金，并在贝德福德被聘为研究健康科学家。在退伍军人事务部，她的研究重点是质量、患者安全、差异和信息学。她的职业目标是成为一名全国公认的独立退伍军人管理局研究员，拥有评估、改进和实施面向患者的电子健康技术并评估其对患者和退伍军人管理局医疗系统的影响的专业知识。第二个目标是确保这些新技术不会扩大差距或造成意想不到的质量或安全问题。她的职业生涯最初将专注于我的HealtheVet。通过这个CDA，她将获得信息学、系统工程、实施科学和差异方面所需的技能，使她能够评估电子健康技术对患者、提供者和退伍军人管理局医疗系统的影响。研究目的：1.分析2007-2010财年退伍军人管理局管理和临床数据集，描述哪些退伍军人目前是MHV(截至2010年4月的NH192,000)的面对面认证(IPA)，哪些不是，并检查IPA状态与患者的社会人口学特征或合并疾病负担之间是否存在显著关联。探讨IPA状态是否对IPA患有糖尿病的退伍军人的中期健康结局有任何影响。假设将包括IPA MHV采用者在疾病负担、健康结果或人口统计学方面是否与非IPA患者不同；使用MHV是否会随着时间的推移而改善中间结果；以及在注册MHV后，IPA患者的中间结果是否比非用户更好。目的2.对未使用MHV的少数族裔退伍军人进行小样本(N=20)的MHV可用性测试。我们将测量这些患者在尝试使用MHV站点执行对自我健康管理重要的任务时的任务时间、错误率和满意度。我们将进行认知访谈，以深入了解用户的想法，并了解如何改进用户界面。我们还将采访这些患者，了解他们访问互联网和沟通偏好的情况，以找出哪些其他沟通方式更可取。目的3.我们将采访正在VA Boston Healthcare System、Bedford VAMC或Togus VAMC中试用安全报文传送的患者(N=40)和提供商(N=30)，了解他们当前的体验、偏好和对安全报文传送的假设。我们将观察安全消息传递团队并进行工作流分析。结果将有助于确定哪些退伍军人不太可能获得IPA MHV，并为退伍军人管理局提供其他方法，帮助无法获得或选择不利用MHV的人群。它们将使我们更好地了解IPA的准入对中期成果的影响。可用性测试将使我们能够了解使用MHV的患者面临的挑战在哪里，以便VA可以改进MHV接口，更适当地针对培训工作，或更好地营销MHV。最后，关注安全消息传递将深入了解目前在全国范围内实施的MHV关键功能的潜在承诺和陷阱。

DESCRIPTION (provided by applicant): Career Objectives: Stephanie Shimada, PhD received her doctorate from Harvard University in 2005, subsequently came to the Bedford VAMC for a HSR&D postdoctoral health services research fellowship, and was hired at Bedford as a Research Health Scientist. Within VA, her research has focused on quality, patient safety, disparities, and informatics. Her career goal is to become a nationally-recognized, independent VA researcher with expertise in evaluating, improving, and implementing patient-facing eHealth technologies and assessing their impact on patients and on the VA healthcare system. A secondary goal is to ensure that these new technologies do not increase disparities or cause unintended quality or safety problems. Her career will initially focus on My HealtheVet. Through this CDA, she will acquire the skills needed in informatics, systems engineering, implementation science, and disparities to allow her to evaluate the impacts of eHealth technologies on patients, providers, and the VA healthcare system. Research Objectives: AIM 1. Analyze VA administrative and clinical datasets for FY2007-2010 to describe which veterans are currently in-person authenticated (IPA) for MHV (NH192,000 as of 4/2010), and which are not, and examine whether there is a significant association between IPA status and patients' sociodemographic characteristics or burden of comorbidities. Explore whether IPA status has any impact on intermediate health outcomes among IPA'd diabetic veterans. Hypotheses will include whether IPA MHV adopters differ from non-IPA patients in disease burden, health outcomes or demographics; whether intermediate outcomes improve over time with the use of MHV; and whether intermediate outcomes are better for IPA'd users than for non-users after enrollment in MHV. AIM 2. Conduct usability testing of MHV with a small sample (N=20) of minority veterans who are non- users of MHV. We will measure the time on task, error rates, and satisfaction of these patients as they attempt to use the MHV site to perform tasks important for self-management of health. We will conduct cognitive interviewing to gain insight as to how users think, and understand how the user interface might be improved. We will also interview these patients about their access to the internet and communication preferences to find out what other modes of communication would be most preferable. AIM 3. We will interview patients (N=40) and providers (N=30) currently piloting secure messaging within the VA Boston Healthcare System, Bedford VAMC, or Togus VAMC about their current experiences, preferences, and assumptions about secure messaging. We will observe secure messaging teams and conduct workflow analyses. Results will help ascertain which veterans are less likely to have IPA MHV access, and provide insight into alternative ways for VA to reach populations who do not have access to or choose not to take advantage of MHV. They will increase our understanding of the effect of IPA'd access on intermediate outcomes. Usability testing will allow us to understand where the challenges lie, if any, in patients accessing MHV so that VA can improve the MHV interface, target training efforts more appropriately, or better market MHV. Finally, focus on secure messaging will provide an in-depth look at the potential promises and pitfalls of a key feature of MHV currently being implemented around the country.