Improving glaucoma self-management with technology-supported counselors

 描述(申请人提供)：在美国，青光眼是导致不可逆性失明的主要原因。然而，至少有一半的青光眼患者没有服用被证明可以防止视力丧失的药物。目前的临床实践缺乏解决这一问题的战略框架。该提案的首要目标是提高遵从性，同时最大限度地提高我们眼科保健人员的效率。该项目旨在利用技术来支持医疗提供者团队提供高质量的个性化教育和咨询，否则只能通过与医生的长期对话才能获得这些教育和咨询。该项目将使用运营工程(OE)，该领域的目标是优化复杂系统和流程的效率，以提供一个框架来提高诊所就诊的效率，以便将个性化咨询和支持整合到标准护理中。OE 将使用工具分析日程安排、工作流程和工作分配，以优化基于团队的眼科护理的应用，以改善对患者自我管理行为的支持。拟议的咨询战略将旨在通过允许相同水平的患者数量来保持患者获得青光眼专科服务的机会。这项工作将完善和试点测试Eyes Guide，这是一种基于计算机的个性化行为改变程序，使经过简短培训的医疗助理能够激励和支持青光眼患者提高自我管理和服药依从性。圆周率和她的指导团队已经开发了一个眼睛指南的原型。在这个项目中，医疗助理接受了以激励性访谈为基础的方法的培训，使用眼科指南向每位患者提供个性化的信息和指导。眼科指南将根据对当前临床实践的操作工程(OE)分析中收集的信息进行改进。OE价值流图将被用来确定在患者就诊期间何时包括额外的教育和咨询。OE计算机建模技术将用于生成不同的理论模型，在这些模型中测试如何将额外的咨询和教育最佳地整合到青光眼患者的护理中。眼科指南计划将在这些分析的基础上进行改进，并在非粘附性青光眼患者中进行试点测试。将评估其对依从性的影响，实时监测，以及依从性的心理社会中介。拟议的培训和研究将使纽曼-凯西博士成为一名独立的青光眼研究人员，拥有有效的健康沟通、操作工程和混合方法干预设计和分析方面的技能。鉴于随着美国人口老龄化，青光眼患病率不断上升，以及随之而来的眼科医生预计将出现短缺，设计、实施和评估基于系统的方法以改进以患者为中心的眼科护理模式至关重要。

 DESCRIPTION (provided by applicant): Glaucoma is a leading cause of irreversible blindness in the United States. Yet, at least one-half of glaucoma patients do not take the medications that are proven to prevent vision loss. Current clinical practice lacks a strategic framework to address this issue. The overarching objective of the proposal is to improve adherence while maximizing the efficiency of our ophthalmic healthcare workforce. The project aims to leverage technology to support medical provider teams to deliver high-quality individualized education and counseling that would otherwise be available only through an extended conversation with a physician. The project will use operations engineering (OE), a field whose goal is to optimize efficiency in complex systems and processes, to provide a framework to increase the efficiency of clinic visits in order to integrate individualized counseling and support into standard care. OE tools will be used to analyze scheduling, work- flow and work-allocations to optimize the application of team-based eye care to improve support for patient's self-management behaviors. The proposed counseling strategy will be designed to maintain patient access to glaucoma specialty services by allowing the same level of patient volume. This work will refine and pilot test the eyeGuide, a computer-based personalized behavior change program that enables medical assistants with brief training to motivate and support glaucoma patients to improve their self-management and medication adherence. The PI and her mentorship team have developed a prototype of the eyeGuide. In this program, medical assistants are trained in motivational interviewing-based approaches to use the eyeGuide to deliver individualized information and coaching to each patient. The eyeGuide will be refined based on information gathered in an operations engineering (OE) analysis of current clinical practice. OE value stream mapping will be used to identify when to include additional education and counseling during a patient's clinic visits. OE computer modeling techniques will be used to generate different theoretical models in which to test how to optimally integrate additional counseling and education into glaucoma patient care. The eyeGuide program will be refined based on these analyses and pilot tested with non-adherent glaucoma patients. Its effect on adherence, monitored in real time, and psychosocial mediators of adherence will be evaluated. The proposed training and research will prepare Dr. Newman-Casey to become an independent glaucoma researcher, with skills in effective health communication, operations engineering, and mixed methods intervention design and analysis. In light of the growing prevalence of glaucoma as the US population ages and concomitant projected shortages of ophthalmologists, the design, implementation and evaluation of systems-based approaches towards an improved model of patient centered eye care is critically important.