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- 急诊科(ED)就诊和住院。成人日间服务中心(ADC)提供通信- 为越来越多的种族多样化的可持续发展病提供基于身份的护理，这些人中的大多数是低收入者。每日一如- ADC跨学科工作人员(包括注册护士、社会工作人员)的评估和系列观察 工作人员和项目主管)支持及早发现PLWD的临床问题。然而，当急性 健康状况发生变化时，希望及时通知初级保健提供者的ADC工作人员 (PCP)往往不能有效地做到这一点。在我之前的研究中，我发现ADC的工作人员依赖传真或 用于传达紧急信息的语音邮件消息。这导致了PCP的延迟或无响应 并允许轻微的健康问题升级为医疗紧急情况。作为ADC中的PLWD数量 增长，迫切需要加强ADC之间重要临床信息的沟通， 初级保健医生和护理人员，以减少昂贵的住院和急诊室就诊。移动医疗(MHealth)干预措施 已被证明可以改善各种医疗保健领域的沟通和临床信息交换 设置，但它们不是为ADC设计的。我寻求K23奖项的目标是成为一名印度人- 一位悬而未决的科学家，他领导了一个研究计划，利用mHealth在- 旨在减少可避免的可避免的可持续发展中的卫生保健利用差距的措施。在经验丰富的 跨学科指导团队，我将在三个领域获得培训：使用综合卫生系统 穿着卫生保健利用的差异，使用以用户为中心的设计原则开发mHealth干预措施- PLES，以及设计和测试行为干预。通过必要的培训，我将执行以下操作 具体目标：(1)确定旨在支持通信的移动健康应用程序的关键域- ADC、PCP和非正式照顾者之间关于可持续发展疾病健康相关需求的讨论；(2)设计和测试 MHealth应用程序的可视化布局，旨在支持ADC、PCP和In- 和(3)开发和研究移动健康应用的可行性和可接受性-- ADC工作人员、专科医生和非正式照顾者在减少PLWD住院和急诊率方面的使用 在6个月的时间里。我的发现将为未来的R01提案提供参考，该提案将测试干预的有效性，使用 一个完全可运行的mHealth应用程序。这项研究意义重大，因为研究结果将被用来改进 提高护理标准，减少PLWD的昂贵和创伤性后果。它还推动了立法从 国家卫生信息技术协调员办公室要求患者能够访问 使用他们首选的智能手机应用程序从他们的医疗记录中获取信息。本研究具有创新性。 因为它利用ADC的优势并结合一线提供商的观点来为开发人员提供信息- 一个务实的以用户为中心的移动健康应用程序，以整合护理和减少PLWD方面的差异。

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoida- ble emergency department (ED) visits and hospitalizations. Adult day service centers (ADCs) provide commu- nity-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily as- sessment 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 communicate 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 communication 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 inde- pendent scientist who leads a research program that integrates care from ADCs and PCPs using mHealth in- terventions 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 ad- dress health care utilization disparities, developing mHealth interventions using user-centered design princi- ples, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) identify the key domains of an mHealth application intended to support communication be- tween ADCs, PCPs, and informal caregivers regarding the health-related needs of PLWD; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and in- formal caregivers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth applica- tion 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 standards 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 information from their medical records using their preferred smartphone application. This study is innovative because it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the develop- ment of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.