Improving Diabetes Care through Effective Personalized Patient Portal Interactions

摘要 目前，超过300万退伍军人采用了VA患者门户网站，我的HealthVet（MHV），但实际上 门户的使用情况差异很大，我们几乎没有关于如何最好地改进门户功能的数据 患者结局或有效使用是否因亚组而异。我们将努力定义有效使用， 临床和管理数据，安全消息编码，患者调查，以及与 丰富的MHV经验。从这项工作中获得的经验教训将用于完善干预措施， 使用MHV门户网站功能进行慢性疾病管理。我们选择将我们的研究锚在 特定疾病领域：2型糖尿病，一种影响许多退伍军人的复杂疾病， 严重的精神和身体共病、并发症和不良结局，需要高水平 自我管理。 在一个全国性的糖尿病不受控制的退伍军人样本中，目标1和2使用了一个嵌套病例队列， 控制设计，以生成个性化干预所需的信息，并定义有效使用 患者入口。目标3是一个小规模的实验，旨在测试MHV支持的收养干预。 我们的具体目标是： 目标1。为功能选择和个性化干预生成新信息。 在一个国家纵向队列的退伍军人与不受控制的2型糖尿病，我们将测试 患者门户工具使用与生理控制指标改善的相关性（H1 a），以及 这种关联对于有精神健康状况的患者和农村地区的患者（H1b）是不同的。 目标二。生成有关患者如何有效使用患者门户的详细信息。 我们将收集血糖（HbA 1c）控制良好（病例）和控制不良的患者数据 （对照）。使用调查和安全的消息编码，我们将检查通信的差异 与临床团队（信息共享，信息寻求，社会情感交流），并在 与家庭和/或非VA提供者共享其门户网站上的信息。 目标3：采用随机激励设计进行小规模实验，以检验 让退伍军人参与支持收养干预，以促进有效的MHV使用，在一个样本中， 200名患有糖尿病的退伍军人（有或没有精神健康问题） 对于目标3，我们将利用与 目标1和目标2中的最大证据，寻求关键利益攸关方对干预措施的反馈（例如，初级保健 提供者、工作人员、患有糖尿病的退伍军人），然后在贝德福德/波士顿VAMC随机分配患者， 被邀请参加干预。评价将侧重于对增加使用MHV的影响， 在未来的综合投资报告中大规模实施完善干预措施的可行性。 这项研究将开发和测试一种干预措施，以改善糖尿病护理，同时加强证据 使用患者门户网站功能的基础，并寻求确保干预措施对农村地区有效 退伍军人和那些患有精神疾病的人。它将创建有关门户功能的新知识 这对管理其他复杂的慢性病应该是有用的。这项研究将在 与外地（VISN 1）和信息学和分析办公室的业务伙伴合作，以及 将通过这些伙伴传播。

Abstract Currently over 3 million Veterans have adopted the VA Patient Portal, My HealtheVet (MHV), however actual use of the portal varies considerably, and we have little data on how the portal features can best improve patient outcomes, or whether effective use varies by subgroups. We will work to define effective use, using clinical and administrative data, coding of secure messages, patient surveys, and in-depth interviews with extensive MHV experience. Lessons from this work will be used to refine an intervention to support effective use of MHV portal features for chronic disease management. We have chosen to anchor our research in a particular disease area: Type 2 diabetes, a complex disease affecting many Veterans associated with significant mental and physical comorbidities, complications and negative outcomes, and requiring high levels of self-management. Among a national sample of Veterans with uncontrolled diabetes, Aims 1 and 2 use a cohort-with-nested-case- control design to generate needed information to personalize interventions and to define effective use of the patient portal. Aim 3 is a small-scale experiment designed to test a MHV supported adoption intervention. Our Specific Aims are to: Aim 1. Generate new information for feature selection and personalizing interventions. In a national longitudinal cohort of Veterans with uncontrolled type 2 diabetes, we will test the association of patient portal tool use with improvements in physiologic measures of control (H1a), and the association will differ for patients with mental health conditions and those in rural areas (H1b). Aim 2. Generate details about how patients are effectively using the patient portal. We will collect data on patients with good glycemic (HbA1c) control (cases) and with poor control (controls). Using surveys and secure message coding, we will examine differences in communication with the clinical team (information sharing, information seeking, socio-emotional exchange), and in sharing information from their portals with family and/or non-VA providers. Aim 3. Conduct a small-scale experiment, using a randomized encouragement design, to test the feasibility of engaging Veterans in supported adoption intervention to promote effective MHV use, in a sample of 200 Veterans with diabetes (with or without comorbid mental health problems) For Aim 3, we will design a supported adoption intervention leveraging the features associated with the greatest evidence in Aims 1 and 2, seek feedback on the intervention from key stakeholders (e.g., primary care providers, staff, Veterans with diabetes), and then randomize patients at the Bedford/Boston VAMCs to be invited to participate in the intervention. Evaluation will focus on impact on increased use of MHV and feasibility of conducting a large scale implementation of the refined intervention in a future IIR. This research will develop and test an intervention to improve diabetes care, while strengthening the evidence base for using patient portal features and seeking to ensure that the intervention will be effective for rural Veterans and those with comorbid mental health diagnoses. It will create new knowledge about portal features that should be useful in managing other complex chronic conditions. This research will be conducted in collaboration with operational partners in the field (VISN 1) and in the Office of Informatics and Analytics, and will be disseminated through those partners.