A Theory-Based Patient Portal eLearning Program for Older Adults with Chronic Illnesses

项目总结/摘要 在美国，慢性病的高患病率是一个严重的公共卫生问题，和70多 100万年龄≥50岁的成年人至少患有一种慢性疾病。慢性病的管理需要长期的 使用复杂的治疗计划，并可能导致意外后果，如增加的风险 用药错误。患者门户网站（PP）是联邦政府支持的健康信息技术（IT），可以 对慢性病患者尤其有帮助。患者现在可以访问自己的健康记录， 通过PP直接与护理提供者沟通。先前的研究结果表明，使用PP的巨大潜力， 提高护理质量，联邦政府资助医疗机构实施该工具 全国范围内（有意义的使用奖励计划）。尽管有潜在的好处，总体PP 美国的采用率很低（2014年全国调查为26.8%）。老年人缺乏PP使用， 被视为特别关注。然而，当只考虑使用互联网的老年人时， 他们使用PP的比例与其他年龄组相似。一些研究还报告说，老年人 一般来说，老年人需要额外的支持来学习使用PPs进行护理。 管理，因为他们往往不太熟悉技术。目前，大多数老年人很少或根本没有收到 PP支持他们的供应商。这是国家卫生信息技术倡议的一个重要差距，因为如果没有 适当的支持，老年人将无法使用这个强大的健康工具，错过了一个重要的机会， 来改善他们的健康状况。为了填补这一空白，在我们的初步研究中，我们开发并测试了 老年人友好的基于理论的患者门户电子学习计划（T-PeP），以支持老年人使用 PP对于他们的照顾。在拟议的可行性研究中，我们计划（目标1）优化和实施供应商- 不可知的T-PeP并进行形成性和过程评估（例如，可用性、促进因素/障碍）;以及（目标2） 评估T-PeP对PP使用和选定结局（PP知识、PP自我效能）的初步影响 使用和健康决策、健康沟通和药物协调）。将进行一项双臂RCT， 在患有慢性疾病的老年人（N=242，年龄≥50）中进行，并在网上招募。数据将 在基线、治疗结束（3周）和4个月时收集。适当的分析方法将 解决每个研究目标，包括描述性统计，线性混合模型和定性分析。如果 成功，这项研究可能会直接影响为老年人提供的护理质量和 国家卫生信息技术倡议。这项研究的结果还将为医院，供应商和政策制定者提供 深入了解老年人目前的PP使用模式和使用各种类型的 国家一级的PP，促进PP技术的进步和实践的改变。在 R 01研究的下一阶段，我们将测试其对健康行为和临床结果的长期影响（例如， 改善HbA 1c）使用更多样化的样本，包括实践环境和服务不足的人群。

Project Summary/Abstract The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million adults age ≥50 have at least one chronic illness. Management of chronic conditions requires long-term use of complex treatment plans and can cause unintended consequences, such as increased risk of medication errors. Patient portals (PPs), a federally supported health information technology (IT), can be especially helpful for patients with chronic illnesses. Patients can now access their own health records and directly communicate with care providers through PPs. Prior findings suggest a great potential for using PPs to improve care quality, and the federal government funds healthcare organizations to implement this tool nationwide (Meaningful Use incentive payment program). Despite the potential benefits, the overall PP adoption rate in the U.S. is low (26.8% in a 2014 national survey). A lack of PP use among older adults has been addressed as a particular concern. When only older adults who use the Internet are considered, however, their proportion of PP use is similar to other age groups. A few studies also reported that older adults are receptive to PPs.In general, older adults need additional support for learning to use PPs for their care management, as they tend to be less familiar with technology. Currently, most older adults receive little or no PP support from their providers. This is an important gap in the nation’s health IT initiative because without appropriate support, older adults will not be able to use this robust health tool, missing an important opportunity to improve their health outcomes. In an effort to fill this gap, in our preliminary study, we developed and tested an older adult friendly Theory-based Patient portal eLearning Program (T-PeP) to support older adults in using PPs for their care. In the proposed feasibility study, we plan to (Aim 1) optimize and implement a vendor- agnostic T-PeP and conduct formative and process evaluations (e.g., usability, facilitators/barriers); and (Aim 2) assess the preliminary impact of T-PeP on PP use and selected outcomes (PP knowledge, self-efficacy for PP use and health decision making, health communication, and medication reconciliation). A two-arm RCT will be conducted with older adults who have chronic conditions (N=242, age ≥50) and are recruited online. Data will be collected at baseline, the end of treatment (3 wks), and 4 months. Appropriate analytic approaches will address each study aim, including descriptive statistics, linear mixed models, and qualitative analyses. If successful, this study could directly affect quality of care provided to older adults and the success of the national health IT initiative. Findings from this study will also provide hospitals, vendors, and policymakers with in-depth information on older adults’current PP usage patterns and other challenges in using various types of PPs at the national level, contributing to the advancement of PP technology and changes in practice. In the next phase of the R01 study, we will test its long-term effects on health behaviors and clinical outcomes (e.g., improvement HbA1c) using more diverse samples, including practice settings and underserved populations.