The HOPE App: An Immersive Telehealth Solution for Older Adults with Diabetes

2型糖尿病(T2 DM)是一种流行病。据估计，美国有3400万人患有2型糖尿病，8400万人患有 有糖尿病前期-其中近一半是65岁以上的成年人，这使得许多老年人面临更高的不健康风险 衰老和认知衰退。健康的生活方式可以治疗甚至逆转T2 DM。但是改变生活方式 是艰难的，许多人失败了，为美国的医疗成本贡献了3270亿美元。糖尿病团体来访(DGV)和 糖尿病自我管理教育和支持(DSME/S)帮助T2 DM患者学习和维持 复杂的疾病管理技能。然而，接触DSME/S的机会是有限的，例如参与DSME/S方案 据报道，在成年T2 DM患者中，这一比例低至7%。支持DSME/S计划的新技术 新兴的，但大多数未能满足老年人的独特需求，技术流畅度有限，创造了一个新的 数字鸿沟。See Yourself Health(SYH)旨在通过一种新的 身临其境的学习和远程医疗应用程序-希望应用程序-旨在提供高影响力、高 接洽糖尿病护理和DSME/S为糖尿病老年患者量身定做。 虚拟现实软件、新的云游戏技术和用户界面设计的进步使 我们的团队设想了一个新的远程健康和沉浸式学习环境，以支持慢性病自我治疗 老年糖尿病患者的管理需求。我们使用虚拟现实、电信技术和 提供实时同伴支持、关怀指导和28个真人体验模块的社交游戏策略 帮助参与者掌握复杂的糖尿病自我管理技能的学习计划。在我们的第一阶段SBIR中 项目，我们达到了以下里程碑：建立了具有云访问和新功能的希望应用程序平台的原型 导航和通信功能；完成可用性测试(SUS=71)，有20个目标用户和 Hope App平台的可行性测试(100%参与)；为老年人开发了新的DSME内容。 在第二阶段，我们将进一步发展希望应用程序的患者参与度和人口健康管理 特点和能力，然后在全功率临床试验中评估其疗效。具体目标1：发展 Hope App提供最先进的沉浸式患者参与体验，具有自动入职、社交 联网和游戏化DSME/S功能，以支持患者长期保留。具体目标2：发展 希望App对人口健康管理的预测分析能力。具体目标3：临床验证 希望应用程序干预对六个月临床结果(A1c)、患者报告的结果(糖尿病)的影响 痛苦)和敬业度(留住病人，坚持DSME/S)。SYH组建了一家专家企业 向我们的目标客户，医疗保健支付者销售希望应用程序的团队。Hope应用程序提供了一个简单、高级的- 影响巨大、极具吸引力、身临其境的远程医疗体验，有可能成为无处不在的糖尿病 管理工具，将糖尿病患者转变为自己护理的高绩效司机。

Type 2 diabetes (T2DM) is an epidemic. An estimated 34 million people in the US have T2DM and 84 million have pre-diabetes - nearly half of whom are adults 65+ yo, putting many older adults at higher risk of unhealthy aging and cognitive decline. A healthy lifestyle can treat and even reverse T2DM. But making lifestyle changes is hard and many people fail, contributing to $327B in US healthcare costs. Diabetes group visits (DGV) and diabetes self- management education and support (DSME/S) help people with T2DM to learn and sustain complex disease management skills. Yet, access to DSME/S is limited such participation in DSME/S programs is reportedly as low as 7% among adults with T2DM. New technologies supporting DSME/S programs are emerging, but most fail to meet the unique needs of older adults with limited technology fluency, creating a new digital divide. See Yourself Health (SYH) aims to bridge this digital health gap for older adults with a newly designed immersive learning and telehealth application – the HOPE App – designed to deliver high-impact, high engagement diabetes care and DSME/S tailored for older adults with diabetes. Advancements in virtual reality software, new cloud gaming technology and user interface design have enabled our team to envision a new telehealth and immersive learning environment to support chronic disease self- management needs of older adults with diabetes. We use virtual reality, telecommunication technology and social gaming strategies to offer real-time peer support, care coaching, and 28 modules of live-action experiential learning programs to help participants master complex diabetes self-management skills. In our Phase I SBIR project, we reached the following milestones: prototyped the HOPE App platform with cloud access and new navigation and communication features; completed usability testing (SUS = 71) with 20 target users and feasibility testing (100% participation) of the HOPE App platform; developed new DSME content for older adults. In Phase II, we will further develop the HOPE App patient engagement and population health management features and capabilities and then assess its efficacy in a fully powered clinical trial. Specific Aim 1: Develop the HOPE App’s state-of-the-art immersive patient engagement experience with automated onboarding, social networking and gamified DSME/S features to support long-term patient retention. Specific Aim 2: Develop the HOPE App’s predictive analytic capabilities for population health management. Specific Aim 3: Clinical validation of the HOPE App intervention on six-month clinical outcomes (A1c), patient reported outcomes (diabetes distress) and engagement (patient retention, adherence to DSME/S). SYH has assembled an expert business team to sell the HOPE APP to our target customer, health care payors. The HOPE APP offers a simple, high- impact, highly engaging, immersive telehealth experience with the potential to become a ubiquitous diabetes management tool to transform diabetes patients into high performing drivers of their own care.