Promoting Safety by Engaging Diverse Diabetes Patients and their Caregivers in Secure Messaging

项目总结/摘要 博士Wagahta Semere的长期职业目标是成为一名独立的临床研究者和领导者， 制定和实施以技术为基础的沟通干预措施， 患者获得有效和安全的慢性病护理。她已经确定了从事糖尿病护理人员 管理是实现这一目标的关键。这份提案描述了她全面的5年 培训和指导研究计划。拟议的工作与AHRQ的数字部门保持一致 医疗保健研究的使命是探索不断发展的数字医疗保健生态系统如何最好地推动 为患者及其家属提供医疗保健的质量、安全性和有效性，并解决了几个AHRQ问题 优先人群（妇女、老年人、少数民族、低收入和慢性病群体）。虽然博士。 Semere拥有强大的健康服务研究背景，此次K 08将提供大数据方面的关键培训 分析，定性和混合方法研究，以及实施科学。慢性沟通 导致共同理解的疾病护理与改善依从性，更好的疾病控制， 更安全的结果。患者门户网站-系统，让病人方便地访问他们的健康信息 在线以及与提供商交换安全消息（SM）的能力-提供了理想的通信 平台，以实现对2型糖尿病（T2 D）的共同理解和更好的结果。照顾者作为 代理，代表患者的消息传递，可以使患者能够并扩大与提供者互动的能力 通过SM平台。然而，代理人在很大程度上仍然是一种未开发的资源，特别是对种族/族裔少数群体来说， 那些有沟通障碍的人，他们可能从代理参与中受益最多。拟议的具体目标 是（1）确定患者使用护理者代理进行安全消息传递（SM）的独立影响， 有和没有代理的T2 D患者的临床结局，（2）比较SM的特征 在使用和不使用护理人员代理的患者中，T2 D患者及其PCP之间的交换，以及 (3)在安全网环境中制定和测试一项试点干预措施，使照顾者参与SM， 有效的沟通和安全的疾病管理。Semere博士的导师团队 由Schillinger博士，包括国家认可的卫生服务研究人员，通信科学家， 定性和混合方法专家，以及实施科学家，他们将共同提供实用的 指导以补充她的教学训练。此外，UCSF的支持性研究环境和 在扎克伯格旧金山弗朗西斯科综合医院的普通内科， 实现拟议的项目目标。在完成拟议的研究和培训后，Semere博士将 提交一份具有竞争力的R级拨款申请，在几个随机试验中测试试点干预措施 安全网诊所她将拥有为患者质量做出有影响力贡献的技能和经验 通过以证据为基础和以家庭为中心的沟通干预，提高慢性病患者的健康和安全性。

Project Summary/Abstract Dr. Wagahta Semere’s long-term career goal is to be an independent clinician-investigator and leader in developing and implementing technology-based communication interventions to engage caregivers for diverse patients in effective and safe chronic disease care. She has identified engaging caregivers in diabetes management as a critical issue to achieve this goal. This proposal describes her comprehensive 5-year program of training and mentored research. The work proposed is aligned with AHRQ’s Division of Digital Healthcare Research mission to explore how the evolving digital healthcare ecosystem can best advance the quality, safety, and effectiveness of healthcare for patients and their families and addresses several AHRQ Priority Populations (women, elderly, racial/ethnic minorities, low income, and chronic illness groups). While Dr. Semere has a strong background in health services research, this K08 will provide key training in large data analytics, qualitative and mixed methods research, and implementation science. Communication in chronic illness care that leads to shared understanding has been linked to improved adherence, better disease control, and safer outcomes. Patient portals—systems that allow patients convenient access to their health information online and the ability to exchange secure messages (SM) with providers—offer an ideal communication platform to achieve shared understanding and better outcomes in type 2 diabetes (T2D). Caregivers acting as proxies, messaging on patients’ behalf, can enable and expand the ability of patients to engage with providers via SM platforms. Yet, proxies largely remain an untapped resource, especially for racial/ethnic minorities and those with communication barriers, who may benefit most from proxy involvement. The proposed specific aims are (1) to determine the independent effect of patient use of caregiver proxies for secure messaging (SM) on clinical outcomes among T2D patients with and without proxies, (2) to compare the characteristics of SM exchange between T2D patients and their PCPs among patients who do and do not use caregiver proxies, and (3) to develop and test a pilot intervention in the safety-net setting to engage caregivers in SM to promote effective communication and safe disease management for T2D patients. Dr. Semere’s mentorship team is led by Dr. Schillinger and includes nationally recognized health services researchers, communication scientists, qualitative and mixed methods experts, and implementation scientists who together will provide practical guidance to complement her didactic training. In addition, the supportive research environments at UCSF and within the Division of General Internal Medicine at Zuckerberg San Francisco General, will enable her to achieve the proposed project aims. Upon completion of the proposed research and training, Dr. Semere will submit a competitive R-level grant application to test the pilot intervention in a randomized trial across several safety-net clinics. She will possess the skills and experience to make impactful contributions to patient quality and safety in chronic disease through evidence-based and family-centered communication interventions.