Effects of a Novel, Scalable, and Sustainable Patient Portal Intervention on Diabetes-Related Outcomes: A Pragmatic Randomized Controlled Trial

项目总结/摘要 迫切需要有效的糖尿病自我管理干预措施，这些干预措施是方便的，可扩展的， 可持续的，能够满足不同患者和那些健康知识有限的人的需求， 不成比例地受到疾病的影响。根据我们的初步研究，我的糖尿病护理（MDC）可能会填补 通过汇集糖尿病mHealth应用程序的一些最佳方面， 将它们转换为患者门户干预，该干预被开发为可与各种电子健康 记录（EHR），并提供直接集成到常规护理，而不会为 医疗团队或需要额外的工作人员。MDC是一种多方面的患者门户干预，旨在 帮助患者更好地了解他们的糖尿病健康数据，并促进和支持自我管理。 MDC是由范德比尔特大学医学中心（VUMC）开发的，它使用信息图表来方便用户 了解他们的糖尿病健康数据，包括动机策略和访问在线 病人支持社区，并提供识字水平适当和定制的糖尿病自我保健信息。 为了确保互操作性和优化可扩展性，我们使用可替代医疗应用程序构建了MDC， 快速医疗保健互操作性资源（FHIR上的SMART）上的可重用技术， 我们的初步研究表明，MDC安装在美国各种各样的EHR平台上， 可接受的，可行的，提高对糖尿病健康措施的理解，并增加患者的积极性。 建议研究的目标是：（1）扩展MDC对用户糖尿病健康数据的显示， 血红蛋白A1 C、血压、胆固醇和流感疫苗接种状况，包括微量白蛋白和BMI， 通过创建西班牙语版本来增加访问;（2）评估扩大和加强的效果 MDC版本对糖尿病相关结果的影响，同时通过将其整合到另一个 卫生系统和进行一个务实的随机对照试验，在一个种族和种族多样化的 患者群体，和（3）研究如何通过研究因果介质MDC的影响。拟议 工作很重要，因为种族/民族少数群体和健康知识有限的人更有可能 在糖尿病自我护理和技术使用方面遇到障碍。通过设计，测试和评估，MDC在 不同的患者群体，包括那些健康知识有限和发展西班牙语的患者 版本，我们将进一步了解如何创建面向患者的健康技术，以实现 广泛吸收和解决卫生不平等问题。通过在FHIR上利用SMART，我们的项目还将展示 通过实施和测试MDC而无需重建它， 未来患者基于门静脉的干预模式。

Project Summary/Abstract There is an urgent need for effective diabetes self-management interventions that are convenient, scalable, sustainable, and able to meet the needs of diverse patients and those with limited health literacy that may be disproportionately affected by the disease. Based on our preliminary studies, My Diabetes Care (MDC) may fill this critical gap by bringing together some of the best aspects of diabetes mHealth apps and incorporating them into a patient portal intervention that was developed to be interoperable with a variety of electronic health records (EHRs) and that offers direct integration into routine care without creating additional work for healthcare teams or the need for additional staff. MDC is a multi-faceted patient portal intervention designed to help patients better understand their diabetes health data as well as promote and support self-management. Developed at Vanderbilt University Medical Center (VUMC), MDC uses infographics to facilitate users' understanding of their diabetes health data, incorporates motivational strategies and access to an online patient support community, and provides literacy level-appropriate and tailored diabetes self-care information. To ensure interoperability and optimize scalability, we built MDC using Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resource (SMART on FHIR) that allows MDC to be installed into a wide variety of EHR platforms across the U.S. Our preliminary studies suggest MDC is acceptable, feasible, improves understanding of diabetes health measures, and increases patient activation. The objective of the proposed research is to: (1) expand MDC's display of user's diabetes health data beyond hemoglobin A1C, blood pressure, cholesterol, and flu vaccination status to include microalbumin and BMI and enhance access by creating a Spanish-language version; (2) evaluate the effects of the expanded & enhanced version of MDC on diabetes-related outcomes while demonstrating its scalability by integrating it into another health system and conducting a pragmatic randomized controlled trial in an ethnically and racially diverse patient population, and (3) examine how the effects of MDC arise by studying causal mediators. The proposed work is important because racial/ethnic minorities and those with limited health literacy are more likely to experience barriers to diabetes self-care and technology use. By designing, testing, and evaluating, MDC in diverse groups of patients including those with limited health literacy and developing a Spanish language version, we will advance the understanding of how to create patient-facing health technologies to achieve broad uptake and address health inequities. By leveraging SMART on FHIR, our project will also demonstrate the current state of the art by implementing and testing MDC without needing to rebuild it and will serve as a model for future patient portal-based interventions.