Leveraging mobile health technology to reduce avoidable healthcare utilization in persons with Alzheimer's Disease and Related Dementias in adult day centers

项目摘要。 社区居住的痴呆症患者(PLWD)非常容易受到可避免的紧急情况的影响 病房(ED)就诊和住院。成人日间服务中心(ADC)为老年人提供社区护理 种族多元化的可持续发展妇女人数越来越多，其中大多数是低收入者。日常评估和连载 ADC跨学科工作人员(包括注册护士、社会工作者和项目)的意见 董事)支持及早发现PLWD的临床问题。然而，当健康状况的急剧变化 发生这种情况时，希望及时通知初级保健提供者(PCP)的ADC工作人员通常无法做到 效率如此之高。在我之前的研究中，我发现ADC的工作人员依赖传真或语音信箱消息来通信- 传达紧急信息。这导致来自PCP的延迟或无响应，并允许轻微健康 问题升级为医疗紧急情况。随着ADC中PLWD数量的增长，存在着迫切的需求 加强ADC、PCP和照顾者之间重要临床信息的沟通，以减少 昂贵的住院和急诊科就诊费用。移动健康(MHealth)干预措施已被证明可以改善 跨各种医疗保健环境的通信和临床信息交换，但它们尚未 专为ADC设计。我寻求K23奖项的目标是成为一名独立的科学家，领导一项新的 搜索计划，使用mHealth干预整合ADC和PCP的护理，以减少可避免的 可持续发展疾病的卫生保健利用不平衡。在经验丰富的跨学科导师的支持下 作为团队成员，我将在三个领域接受培训：使用综合卫生系统解决卫生保健利用问题 差异，使用以用户为中心的设计原则开发mHealth干预措施，以及设计和测试 行为干预。通过必要的培训，我将执行以下具体目标：(1)识别患者 护理者报告了可以集成到mHealth应用程序中的警告信号，以解决 ADC中PLWD出现的临床问题和痛苦症状；(2)设计和测试视觉 MHealth应用程序的布局，旨在支持ADC、PCP和非正式护理之间的通信- PLWD的给予者；以及(3)开发和检查mHealth应用使用的可行性和可接受性 在ADC工作人员、初级保健医生和非正式照顾者中，PLWD的住院和急诊就诊减少了6- 一个月的期间。我的发现将为未来的R01提案提供参考，该提案将使用完全的 运营中的mHealth应用程序。这项研究具有重要意义，因为研究结果将用于改善站立状态。 改善护理，减少PLWD的昂贵和创伤性后果。它还推动了来自办公室的立法 国家卫生信息技术协调员要求患者能够访问信息- 使用他们喜欢的智能手机应用程序从他们的医疗记录中获取信息。本研究的创新之处在于： 因为它利用ADC的优势并结合一线提供商的观点来为开发提供信息 一个务实的以用户为中心的mHealth应用程序，以整合护理并减少PLWD方面的差异。

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoidable emergency de- partment (ED) visits and hospitalizations. Adult day service centers (ADCs) provide community-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily assessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to com- municate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve com- munication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an independent scientist who leads a re- search program that integrates care from ADCs and PCPs using mHealth interventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to address health care utilization disparities, developing mHealth interventions using user-centered design principles, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) Identify patient and caregiver reported warning signs that can be integrated into an mhealth application in order to address emerging clinical problems and distressing symptoms among PLWD in ADCs; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and informal care- givers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth application use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6- month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve stand- ards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access infor- mation from their medical records using their preferred smartphone application. This study is innovative be- cause it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the development of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.