Understanding the Impact of Technology Access and Digital Literacy on Post-Discharge Care and Hospital Readmissions in Adults with Cardiovascular Disease

项目总结 这一R03奖项将扩大家长K23奖项的范围，以帮助Oanh Nguyen博士成为 临床医生-研究人员专注于设计、实施和评估新的过渡性护理干预措施 解决社会脆弱性问题，同时满足医疗需求，以改善弱势群体的健康状况 患有心血管疾病的患者。这项奖励将使她能够扩大她的父母K23的工作范围 了解社会脆弱性如何影响出院后护理也包括了解 将有限的技术获取和数字素养视为社会脆弱性，可能会加剧已经存在的 充血性心力衰竭(CHF)和缺血性心脏病(IHD)再入院和术后的差异 出院护理。由于史无前例的住院后护理服务转向远程医疗， 新冠肺炎的流行，一个日益重要但未被认识到的社会需求是有限的获取和使用 在服务不足的人群中开展远程保健。最近，向远程医疗的快速、震撼的转变已经发生 没有注意到安全网卫生系统中患者远程保健的障碍和促进者 来自低收入和少数族裔背景的美国人已经不太可能跟进所需的 出院时的门诊护理，这些差异可能会随着门诊护理的提供而恶化到 远程医疗，因为低收入个人使用远程医疗的可能性也低于其他患者亚组和 因此，接受严重出院后门诊随访的可能性更低。尽管技术接入 和数字素养是使用远程保健、技术普及和数字素养的基础 在住院患者中；有限的技术获取和数字素养如何影响出院后 护理/康复；以及在服务不足的成年人中使用远程保健的患者感知的障碍和促进因素 因CHF和IHD入院治疗的情况不详。 根据她的临床经验和初步研究，并使用COM-B模型进行行为 作为一个概念框架，阮博士将进行一系列研究：1)开发和进行 前瞻性调查研究，以了解技术获取和数字素养的普及率，以及态度 对患有CHF和IHD的住院成年人进行远程医疗(目标1)，以及2)了解患者对 技术获取和数字素养如何影响出院后护理和康复以及患者感知 远程保健的障碍和推动因素(目标2)。这些发现和她的父母K23的发现将形成 R01申请完全有效的随机对照试验以评估医院的影响的基础- 以患者为中心的个性化干预措施，以改善护理过渡和防止再入院 除其他社会脆弱性外，通过改善出院后护理以及远程保健的获取和使用方面的公平 在因CHF和IHD住院的服务不足的成年人中。

PROJECT SUMMARY This R03 award will extend the scope of a parent K23 award to help establish Dr. Oanh Nguyen as a clinician-investigator focused on designing, implementing, and evaluating novel transitional care interventions that address social vulnerabilities in tandem with medical needs to improve health outcomes for vulnerable patients with cardiovascular illness. This award will enable her to extend the scope of her parent K23 work on understanding how social vulnerabilities affect post-discharge care to also encompass understanding the role of limited technology access and digital literacy as social vulnerabilities that may exacerbate already-existing disparities in congestive heart failure (CHF) and ischemic heart disease (IHD) readmissions and post- discharge care. As post-hospitalization care delivery has shifted to telehealth due to the unprecedented COVID-19 pandemic, an increasingly important but underrecognized social need is limited access and use of telehealth among underserved populations. The recent rapid, seismic shift to telehealth has taken place without attention to barriers and facilitators to telehealth among patients in safety-net health systems across the U.S. Individuals from low-income and minority backgrounds are already less likely to follow up with needed outpatient care at discharge, and these disparities are likely worsen with the in outpatient care delivery to telehealth, since low-income individuals are also less likely to use telehealth than other patient subgroups and thus will be even less likely to receive critical post-discharge outpatient follow-up. Although technology access and digital literacy are foundational to using telehealth, the prevalence of technology access and digital literacy among hospitalized patients; how limited technology access and digital literacy affects post-discharge care/recovery; and patient-perceived barriers and enablers to telehealth use among underserved adults hospitalized for CHF and IHD is unknown. Informed by her clinical experience and preliminary studies, and using the COM-B model for behavioral change as a conceptual framework, Dr. Nguyen will conduct a series of studies to: 1) develop and conduct a prospective survey study to understand the prevalence of technology access and digital literacy, and attitudes to telehealth among hospitalized adults with CHF and IHD (Aim 1), and 2) understand patient perceptions on how technology access and digital literacy affect post-discharge care and recovery, and patient-perceived barriers and enablers to telehealth (Aim 2). These findings along with those from her parent K23 will form the basis for an R01 application for a fully powered randomized controlled trial to assess the impact of a hospital- based, personalized, and patient-centered intervention to improve care transitions and prevent readmissions by improving equity in post-discharge care and access and use of telehealth among other social vulnerabilities in underserved adults hospitalized with CHF and IHD.