Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults

项目总结 AHRQ之前资助了Elder Tree(ET)的开发，这是一个基于笔记本电脑的电子健康系统，如 改善患有多种慢性病的老年人的生活质量和健康因素的随机试验 (MCCS)，如糖尿病和高血压。MCC在老年人中普遍存在，成本也很高，减少了 生活质量和占医疗保险支出的90%。自我管理可以帮助患者控制他们的 但这些技能很少在初级保健中传授。ET为这样的自我提供工具和支持 管理和解决所有MCC患者共同的挫败感、气馁和孤独， 而不考虑具体的疾病。尽管结果是积极的，但许多研究参与者没有使用ET 广泛地说，这是所有健康应用程序的问题。在另一项调查中，我们了解到超过60%的非用户 放弃了ET，因为计算机太难使用了。声控的“智能”技术可能会解决这个问题 有问题。智能扬声器，用于说和听，而不是打字和阅读，避免了使用障碍 例如视力差、震颤和界面复杂性；它们被采用的速度比 互联网或电视，尤其是在老年人中。智能显示器用视觉元素增强了系统， 帮助用户记住内容并创建对要观看的媒体的访问权限。 这个应用程序提出了测试声控技术的能力，以扩大实施和 继续使用经过验证的电子医疗系统。具体地说，我们建议测试老年人是否患有 MCCS将使用智能系统(扬声器和显示器)提供的ET并从其中获益更多，因为 使用，而不是从笔记本电脑版本的ET。该方案有两个目的：1)开发智能系统平台(ET-SS) 2)在双臂RCT上与Laptop ET(ET-LT)进行对比测试。该试验将220名年龄在65岁以上的患者随机分为4名或4名 更多的慢性疾病接受8个月的ET-LT或ET-SS。我们假设： ·ET-SS(与ET-LT相比)患者在第8个月将有更多的ET使用和更好的生活质量。 ·这些临床结果将改善：a)30天再次住院)，b)用药依从性，c) HbA1c、mg/dL、毫米汞柱、FEV-1、BMI、PHQ-8、Fas-GFR和简明疼痛问卷的综合评分。 ·4个月的ET使用量将在8个月时调节ET的效果(即4个月更多地使用ET 月=8个月更大的影响)，以及负面情绪和自我决定理论构建 能力、社会关系和内在动机将在使用电子烟的效果中起中介作用。 ·ET-SS对女性和患有6+(4-5)慢性疾病的患者将有更好的结果。 我们，开发ET的研究人员，已经对eHealth系统进行了大量的随机对照试验，并发表了 广泛地。据我们所知，这将是智能系统作为平台实施的第一个大型RCT 并传播健康干预措施。这一结果可能会使ET对老年人来说更容易获得和更有效 改善患者的生活质量，并为未来电子健康创新的更有影响力的交付指明了方向。

PROJECT SUMMARY AHRQ previously funded the development of Elder Tree (ET), a laptop-based eHealth system shown in a randomized trial to improve quality of life and health factors among older adults with multiple chronic conditions (MCCs) such as diabetes and hypertension. MCCs are pervasive and costly among older adults, reducing quality of life and accounting for 90% of Medicare spending. Self-management can help patients control their conditions, but these skills are rarely taught in primary care. ET provides tools and support for such self- management and addresses the frustration, discouragement, and loneliness shared by all patients with MCCs, regardless of specific disease. Despite positive results, though, many study participants did not use ET extensively, a problem for all health apps. In a separate survey, we learned that more than 60% of non-users abandoned ET because the computer was too hard to use. Voice-controlled "smart" technology may solve this problem. Smart speakers, used by speaking and listening rather than typing and reading, avoid barriers to use such as poor vision, tremors, and interface complexity; they have been adopted at a rate faster than the Internet or TV, especially among older adults. Smart displays enhance the system with a visual element, helping users remember content and creating access to media meant to be viewed. This application proposes to test the ability of voice-activated technology to expand the implementation and sustain the use of a proven electronic health system. Specifically, we propose to test whether older adults with MCCs will use and benefit more from ET delivered by a smart system (speaker plus display), due to ease of use, than from a laptop version of ET. The proposal has 2 aims: 1) develop the smart system platform (ET-SS) and 2) test it against laptop ET (ET-LT) in a 2-arm RCT. The trial will randomize 220 patients age 65+ with 4 or more chronic conditions to receive for 8 months either ET-LT or ET-SS. We hypothesize that: · patients with ET-SS (vs. ET-LT) will have greater ET use and better quality of life in month 8. · these clinical outcomes will improve: a) 30-day hospital readmissions), b) medication adherence, and c) composite score of HbA1c, mg/dL, mmHg, FEV-1, BMI, PHQ-8, FAS-GFR, and Brief Pain Inventory. · the amount of ET use at 4 months will mediate the effects of ET at 8 months (i.e. greater use at 4 months=greater effects at 8 months), and negative affect and Self-Determination Theory constructs of competence, social relatedness, and intrinsic motivation will mediate the effects of ET use. · ET-SS will have better outcomes for women and for patients with 6+ (vs. 4-5) chronic conditions. We, the investigators who developed ET, have conducted numerous RCTs of eHealth systems and published extensively. To our knowledge, this will be the first large RCT of a smart system as a platform to implement and disseminate a health intervention. The result could make ET more accessible and effective for older patients, improve their quality of life, and point the way to more impactful delivery of future eHealth innovations.