Engaging Diverse Patients in Using an Online Patient Portal

描述(由申请人提供)：这是一份K99/R00奖的申请书，授予考特尼·莱尔斯博士，她是加州大学旧金山分校的卫生服务研究员，正在调查不同糖尿病患者的卫生信息技术使用情况。该奖项将为她过渡到独立学术研究人员并实现以下目标提供支持：1)成为使用比较有效性研究方法了解在线患者门户网站使用对少数族裔群体中糖尿病结果影响的专家；2)运用定性和实施科学技能来了解门户网站使用的障碍并设计一种新的患者参与方法；3)在具有成熟电子系统(Kaiser Permanente North California)和目前正在实施在线患者门户网站的安全网公立医院系统(旧金山总医院，SFGH)的集成交付系统中应用这些严格的方法。莱尔斯博士组建了一个多学科指导团队，由医学博士迪恩·席林格博士领导，他是设计和严格评估这种安全网环境下的创新干预措施的专家。该团队还包括：Andrew Karter博士，Kaiser公司高级研究员，在种族/民族医疗保健差异和比较有效性方法学方面拥有专业知识；Rena Pasick博士，加州大学旧金山分校教授，在混合方法方法方面的全国领导者，以了解不同的患者偏好和需求；James Ralston博士，医学博士，公共卫生硕士，团体健康研究所研究员，患者门户网站和设计利用技术改善糖尿病护理的干预措施方面的专家；Ralph Gonzales博士，医学博士，加州大学旧金山分校教授，在实施科学和评估安全网内的创新方面拥有深厚的专业知识。尽管在全国范围内门户网站的使用存在明显的种族/民族差异，但我们对如何让不同的患者利用这些技术将他们的护理扩展到面对面的办公室访问之外，以改善糖尿病的自我护理和管理知之甚少。在目标1中，我们将在Kaiser的种族/少数民族患者中确定门户使用与糖尿病结局(通过依从性、错过预约和临床控制来衡量)之间的联系。在目标2中，我们将过渡到SFGH来定性评估糖尿病患者使用门户的障碍，采用以用户为中心的设计方法。最后，在目标3中，我们将设计和测试一个新的计划，解决患者报告的使用障碍，并培训SFGH患者访问门户，作为其护理常规的一部分。这项工作使更广泛和更多样化的患者群体积极参与使用门户等新的健康信息技术，有可能改善健康结果，减少护理方面的总体差距。

DESCRIPTION (provided by applicant): This is an application for a K99/R00 award for Dr. Courtney Lyles, PhD, a health services researcher at the University of California San Francisco, who is establishing herself as a young investigator examining health information technology use among diverse diabetes patients. This award will provide her with the support to transition to an independent academic researcher and to accomplish the following goals: 1) to become an expert in using comparative effectiveness research methods to understand the influence of online patient portal use on diabetes outcomes within racial/ethnic minority groups, 2) to employ qualitative and implementation science skills to understand barriers to portal use and to design a new approach to patient engagement, 3) to apply these rigorous approaches within an integrated delivery system with a mature electronic system (Kaiser Permanente Northern California) and a safety net public hospital system currently implementing an online patient portal (San Francisco General Hospital, SFGH). Dr. Lyles has assembled a multi-disciplinary mentoring team, led by Dr. Dean Schillinger, MD, who is an expert in designing and rigorously evaluating innovative interventions in this safety net setting. This team also includes: Dr. Andrew Karter, PhD, a senior investigator at Kaiser with expertise in racial/ethnic healthcare disparities and comparative effectiveness methodologies; Dr. Rena Pasick, DrPH, a professor at UCSF who is a national leader in mixed methods approaches to understanding diverse patient preferences and needs; Dr. James Ralston, MD, MPH, an investigator at Group Health Research Institute who is an expert in patient portals and designing interventions utilizing technology to improve diabetes care; and Dr. Ralph Gonzales, MD, a professor at UCSF with deep expertise in implementation science and evaluating innovations within the safety net. Although there are marked racial/ethnic disparities in portal use nationwide, we know little about how to engage diverse patients in utilizing these technologies to extend their care beyond in-person office visits to improve diabetes self-care and management. In Aim 1, we will determine the link between portal use and diabetes outcomes (measured by adherence, missed appointments, and clinical control) among racial/ethnic minority patients at Kaiser. In Aim 2, we will transition to SFGH to qualitatively assess barriers to portal use among diabetes patients, employing user-centered design methodologies. And finally in Aim 3, we will design and test a novel program that addresses patient-reported barriers to use and trains SFGH patients to access the portal as part of their care routine. This work to actively engage a broader and more diverse group of patients in using new health information technology such as portals has the potential to improve health outcomes and reduce overall disparities in care.