Personal Health Record-Facilitated Diabetes Self-Management Among Rural Veterans

对退伍军人保健的预期影响：拟议的项目提供了一个潜在的解决方案 通过对慢性病的干预加强退伍军人对慢性病的自我管理 可访问的自我管理工具，退伍军人管理局的PHR-My HealtheVet，促进知识和技能建设 糖尿病自我管理的几个方面。建议的方法为以下方面创建了灵活且可访问的策略 增长知识，发展自我监控技能，建立自我效能，提高患者素质 赋权。因此，对使用MHV作为技能培养工具的积极指导将促进采用适当的 自我监控行为。拟议的项目旨在产生一个更以患者为导向的过程 和护理质量，以及疾病管理。此外，该项目将提供早期证据，以增加 在弱势退伍军人群体中采用和使用MHV。 背景：退伍军人背负着不成比例的糖尿病诊断负担，与之相比，患病率为24% 至全国8.3%。病人层面的因素占病人护理和健康管理的95%。可怜的病人 知识/信息和参与是造成#年最普遍差距的两个关键因素。 退伍军人医疗系统，患者的激活和依从性干预可能有助于减少 护理方面存在差异，但患者的自我护理行为参与率较低。医疗保健系统有 已建立的个人健康记录(PHR)，例如My HealtheVet(MHV)，使患者能够访问 他们自己的健康记录，获取健康信息，并与提供者沟通他们的疾病 条件。这项研究建议通过以下方式激活患者并改善患者的糖尿病相关行为 开发一种适应的简短的MHV驱动的患者激活和自我护理干预，以增强DSM 高危农村退伍军人的技能(例如，体力活动、饮食、服药依从性和自我监测)。 目标：本研究的目标是：(A)调整一个简短的My HealtheVet(MHV)干预措施，以 增强其对糖尿病退伍军人的适宜性，增加患者的积极性和需求侧管理技能；(B) 改编的MHV简易干预对农村需求侧管理技能影响的可行性及初步效果 以及(C)评估退伍军人在适应后的简短MHV干预方面的经验，并确定 认识到其使用的障碍、促进者和推动者，并评估更广泛传播的潜力。 方法：为了实现这些目标，我们将开发一种针对DSM的适当的简短MHV干预 技能。对My HealtheVet的功能进行培训(设定目标、输入/跟踪数据、研究与健康相关的内容 信息、安全消息传递)将首先开发。我们将获得至少一个非随机样本 20名农村退伍军人，年龄45岁以上，患有糖尿病和社区高血压或高脂血症- 总部设在弗吉尼亚州查尔斯顿集水区的门诊诊所。干预将包括最初的面对面 与远程提供的其余干预会话进行会话。此外，每周提醒(或助推器) 消息)将通过MHV安全消息发送给每个参与者。所有参与者都将接受 在基线和6周随访时进行评估。对于那些同意的人，半结构化的电话采访 将与研究参与者一起评估退伍军人学习和驾驶MHV的经验 通过干预并评估可行性、易用性和精细化，以潜在地传播到 更广泛的受众。主要结果、使用MHV的频率和满意度以及次要结果， 将在基线和6周时评估所有参与者的DSM技能和临床指标的变化 后续行动。定量分析将涉及采用率和混合效应模型。主要的定性 分析将包括认知访谈和半结构化访谈的语篇分析。

Anticipated Impacts on Veterans Health Care: The proposed project offers a potential solution to strengthening Veterans' self-management of chronic disease conditions through intervention to an easily accessible, self-management tool, the VA's PHR - My HealtheVet that fosters the knowledge and skill-building aspects of diabetes self-management. The proposed approach creates flexible and accessible strategies for increasing knowledge, developing self-monitoring skills, building self-efficacy and enhancing patient empowerment. Thus, active orientation to the use of MHV as a skill-building tool will foster adoption of proper self-monitoring behaviors. The proposed project serves to yield a more patient-oriented process in access to and quality of care, and disease management. Furthermore, this project will provide early evidence to increase adoption and use of MHV in disadvantaged Veteran groups. Background: Veterans bear a disproportionate burden of diagnosed diabetes at a 24% prevalence compared to 8.3% nationally. Patient-level factors account for >95% of patient care and health management. Poor patient knowledge/information and participation are two key factors responsible for the most prevalent disparities in the VA healthcare system for which patient activation and adherence interventions may help to reduce disparities in care, but patients have a low rate of engagement in self-care behaviors. Healthcare systems have established personal health records (PHRs), such as My HealtheVet (MHV), that enable patients to access their own health records, obtain health information, and communicate with providers about their disease conditions. This study proposes to activate patients and improve patient diabetes-related behaviors through development of an adapted brief MHV-driven patient activation and self-care intervention that enhances DSM skills (e.g., physical activity, diet, medication adherence, and self-monitoring) in high-risk, rural Veterans. Objectives: The objectives of this study are to: (a) Adapt a brief My HealtheVet (MHV) intervention to enhance its appropriateness for Veterans with diabetes increase patient activation and DSM skills; (b) test feasibility and preliminary effectiveness of the adapted brief MHV intervention on DSM skills in rural Veterans; and (c) evaluate Veterans' experience with the adapted brief MHV intervention and identify perceived barriers, facilitators, and enablers of its use, and assess the potential for wider dissemination. Methods: To achieve these objectives, we will develop an adapted brief MHV intervention that targets DSM skills. Training for features of My HealtheVet (setting goals, entering/tracking data, researching health-related information, secure messaging) will first be developed. We will obtain a nonrandomized sample of at least 20 rural Veterans, age 45+ years, with diabetes and either hypertension or hyperlipidemia from community- based outpatient clinics in the Charleston VA catchment area. The intervention will involve an initial in-person session with the rest of intervention sessions delivered remotely. In addition, weekly reminders (or booster messages) will be sent to each participant through the MHV secure messaging. All participants will undergo assessments at baseline and at 6 weeks follow-up. For those who agree, semi-structured telephone interviews will be conducted with study participants to evaluate Veterans' experience with learning and navigating MHV through the intervention and to assess feasibility, ease of use, and refinement for potential dissemination to a broader audience. Primary outcomes, frequency of and satisfaction with MHV use, and secondary outcomes, change in DSM skills and clinical indicators, will be assessed in all participants at baseline and at 6 weeks follow-up. Quantitative analysis will involve rate of adoption and mixed effects models. The primary qualitative analysis will involve cognitive interviewing and discourse analysis of semi-structured interviews.