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

项目摘要/摘要 Wagahta Semere博士的长期职业目标是成为一名独立的临床医生、研究员和 开发和实施以技术为基础的沟通干预措施，以吸引不同类型的照顾者 对慢性病患者进行有效、安全的护理。她已经确定了糖尿病患者的积极照顾者 管理是实现这一目标的关键问题。这份提案描述了她全面的5年期 培训计划和辅导性研究。建议的工作与AHRQ的数字部门保持一致 医疗研究使命，探索不断发展的数字医疗生态系统如何最好地推动 为患者及其家人提供的医疗保健的质量、安全性和有效性，并解决了几个AHRQ 优先人群(妇女、老年人、种族/少数民族、低收入和慢性病群体)。而Dr. Semere在健康服务研究方面有很强的背景，这款K08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。慢性病患者的沟通 导致共同理解的疾病护理与提高依从性、更好地控制疾病、 和更安全的结果。患者门户-允许患者方便地访问其健康信息的系统 在线和与提供商交换安全消息(SM)的能力-提供理想的通信 实现对2型糖尿病(T2D)的共同理解和更好结果的平台。照顾者充当 代表患者发送消息的代理可以支持和扩展患者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/族裔少数群体和 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 (1)确定患者使用护理者代理进行安全消息传递(SM)的独立效果 有无替代物的T2D患者的临床结局：(2)比较SM的特征 使用和不使用护理者代理的T2D患者和他们的PCP之间的交换，以及 (3)在安全网环境中开发和测试试点干预措施，以吸引SM中的照顾者以促进 T2D患者的有效沟通和安全的疾病管理。塞米尔博士的导师团队是由 由Schillinger博士撰写，包括国家公认的卫生服务研究人员、传播科学家、 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 指导以补充她的说教训练。此外，加州大学旧金山分校的支持性研究环境和 在扎克伯格旧金山综合医院的普通内科部门，将使她能够 实现拟议的项目目标。在完成拟议的研究和培训后，塞梅尔博士将 提交竞争性R级拨款申请，以在一项随机试验中测试试点干预措施，该试验涉及几个 安全网诊所。她将拥有技能和经验，为患者质量做出有影响力的贡献 通过循证和以家庭为中心的沟通干预，提高慢性病的安全性。

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.