An Assessment of Open Access Audio of the Clinical Encounter on Veterans and their Care

背景：就讨论的信息量而言，医疗接触可能是压倒性的， 技术性，以及它可能产生的焦虑。从任何互联网轻松访问安全的音频记录 启用的设备是一种可用的低成本技术，允许患者单独或 与看护人和家人分享。它已经在VA之外进行了介绍和测试，有证据表明， 增加患者的回忆和理解，甚至可以提高医生的表现。我们所知甚少， 然而，关于这些影响是否以及在多大程度上导致更好的结果，例如改善 坚持治疗计划和慢性病自我管理。 意义/影响：这项研究将评估一种新的资源，以提高退伍军人的理解能力。 他们的护理计划，并与护理人员分享他们访问的信息。研究设计旨在产生 信息，以指导决策者将“开放获取音频”（OAA）引入VHA的价值。 创新：开放图表运动，患者可以自由访问他们的书面医疗信息 是2010年首次通过患者门户网站推出的一项重大创新，并迅速传播- 包括VHA内部。高龄津贴扩展了完全透明和容易获得医疗服务的相同原则， 信息，并且如果成功的话，还可以被并入患者门户。VHA办公室 管理MyHealthVet的Connected Care表示对该项目感兴趣，因为它具有潜力 改造下一代门户网站。 具体目的：本研究将采用随机对照试验设计，评估 OAA（更好的病人回忆和理解）导致几个期望的服务利用和医疗保健结果。它 还将衡量高龄津贴对可能介导这些结果的提供者行为的影响。在整个过程中， 收集参与者和其他利益相关者对该计划的看法，根据先前对音频的研究， 在临床环境中记录，反映了准备采用新技术。 目标1：评估开放获取音频程序对两种行为（患者激活、治疗）的影响 计划依从性），以及两项慢性病指标（糖化血红蛋白、血压）。 二次分析将描述性测量对艾德就诊和住院的影响大小。 目标2：评估开放获取音频对提供者沟通及其对患者关注的影响 背景因素（即与规划有效护理相关的个体退伍军人需求和情况）。 目标3：评估患者、医疗服务提供者和领导层对项目安全性的认识， 这是一项繁重的工作，在项目开始和两年之后都是值得的。 方法：设置将是初级保健和糖尿病诊所，在两个设施的普遍性。到 为了达到目的1和2，我们提出了一种随机对照的三臂设计：（1）记录相遇， 提供者和患者知道，并上传到服务器，退伍军人，提供者和研究团队可以 访问访问后访问;（2）记录遭遇，双方都知道，并上传到服务器，只有 研究团队可以访问;和（3）记录遭遇，只有病人知道，并上传到一个 只有研究团队才能访问的服务器。目标1所列的资源利用和疾病措施 所有臂均采集2份。“1”组和“2”组的比较能够评估 关于患者的音频可用性（目标1）。“2”组与“3”组的比较能够分离出 提供者知道他们正在被记录（目标2）。aim 3的数据将来自调查工具focus 小组和半结构化的领导访谈，以了解项目的安全性、负担和价值。 下一步/实施：我们将与互联健康办公室合作，确定机会， 基于将开放音频访问纳入下一代患者门户的调查结果。

Background: The medical encounter can be overwhelming in term of the amount of information discussed, its technical nature, and the anxiety it can generate. Easy access to a secure audio recording from any internet enabled device is an available low cost technology that allows patients to “revisit the visit” either alone or sharing with caretakers and family. It has been introduced and tested outside the VA with evidence that it increases patient recall and understanding and may even improve physician performance. Little is known, however, about whether and to what extent these effects lead to better outcomes, such as improved treatment plan adherence and chronic disease self-management. Significance/Impact: This study will assess a new resource for enhancing Veterans capacity to understand their care plan, and share information from their visit with caregivers. The study design is intended to yield information to guide decision makers about the value of bringing “open access audio” (OAA) to VHA. Innovation: The Open Chart movement, in which patients can freely access their written medical information was a major innovation first introduced through the patient portal in 2010, and is rapidly disseminating-- including within VHA. OAA extends the same principles of full transparency and easy access to medical information and, if successful, could also be incorporated into the patient portal. The VHA Office of Connected Care, which manages MyHealtheVet has indicated interest in this project because of its potential to transform the next generation portal. Specific Aims: This study will access, using a randomized controlled trial design, whether the known benefits of OAA (better patient recall and understanding) lead to several desired service utilization and health care outcomes. It will also measure the effect of OAA on provider behaviors that may mediate those outcomes. Throughout, data will be collected on participant and other stakeholder perceptions of the program that, based on prior research on audio- recording in the clinical setting, reflect a readiness to adopt the new technology. Aim 1: Assess the impact of an open access audio program on two behaviors (patient activation, treatment plan adherence), and two chronic condition measures (glycosylated hemoglobin, blood pressure). Secondary analysis will descriptively measure effect size on ED visits and hospital admissions. Aim 2: Assess the impact of open access audio on provider communication and on their attention to patient contextual factors (i.e. individual Veterans needs and circumstances relevant to planning effective care). Aim 3: Assess patient, provider, and leadership perceptions of the extent to which the program is safe, not burdensome, and worthwhile at both the start and at two years into the program. Methodology: The setting will be primary care and diabetes clinics, at two facilities for generalizability. To achieve aims 1 and 2, we propose a randomized controlled three arm design: (1) the encounter is recorded, with provider and patient aware, and uploaded to a server the Veteran, provider, and research team can access post visit; (2) the encounter is recorded, with both parties aware, and uploaded to a server only the research team can access; and (3) the encounter is recorded, with only the patient aware, and uploaded to a server only the research team can access. Resource utilization and disease measures indicated in aims 1 and 2 will be collected in all arms. Comparisons of Arms “1” and “2” enable assessing the impact of the availability of audio on patients (for aim 1). Comparisons of Arm “2” with “3” enables isolating the effect of providers knowing they are being recorded (for aim 2). Data for aim 3 will come from survey tools, focus groups and semi-structured leadership interviews to elicit perceptions of project safety, burden, and value. Next Steps/Implementation: We will work with the Office of Connected Health to identify opportunities, based on the findings for incorporating Open Audio Access into the next generation patient portal.