Optimizing Veterans Use of eHealth Technologies

描述（由申请人提供）： 职业目标：Stephanie Shimada博士于2005年获得哈佛大学博士学位，随后来到贝德福德VAMC获得HSR&D博士后健康服务研究奖学金，并被贝德福德聘为研究健康科学家。在VA，她的研究集中在质量，患者安全，差异和信息学。她的职业目标是成为一个国家认可的，独立的VA研究人员在评估，改进和实施面向患者的电子健康技术和评估其对患者和VA医疗保健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增加差距或导致意外的质量或安全问题。她的职业生涯最初将集中在我的健康兽医。通过这个CDA，她将获得信息学，系统工程，实施科学和差异所需的技能，使她能够评估电子健康技术对患者，供应商和VA医疗保健系统的影响。研究目的：目的1。分析2007 -2010财年的VA管理和临床数据集，以描述哪些退伍军人目前接受了MHV的亲自认证（IPA）（截至2010年4月为192，000 NH 2），哪些没有，并检查IPA状态与患者的社会人口统计学特征或合并症负担之间是否存在显著相关性。探讨IPA状态是否对IPA糖尿病退伍军人的中间健康结果有任何影响。假设将包括IPA MHV采用者在疾病负担、健康结局或人口统计学方面是否与非IPA患者不同;中间结局是否随着使用MHV而随时间推移而改善;以及在入组MHV后，IPA使用者的中间结局是否优于非使用者。 AIM 2.使用非MHV用户的少数退伍军人的小样本（N=20）进行MHV的可用性测试。我们将测量这些患者尝试使用MHV站点执行对自我健康管理很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，了解他们对互联网的访问和沟通偏好，以找出最可取的其他沟通模式。 AIM 3.我们将采访目前在VA波士顿医疗保健系统、贝德福德VAMC或Togus VAMC中试用安全消息的患者（N=40）和提供者（N=30），了解他们目前对安全消息的体验、偏好和假设。我们将观察安全消息传递团队并进行工作流程分析。 结果将有助于确定哪些退伍军人不太可能获得IPA MHV，并为VA接触无法获得或选择不利用MHV的人群提供替代方法。它们将使我们更好地理解IPA对中间结果的影响。可用性测试将使我们能够了解患者访问MHV时的挑战所在（如果有），以便VA能够改进MHV界面，更适当地定位培训工作，或更好地销售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.