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，其 技术性质，以及由此可能产生的焦虑。从任何互联网轻松访问安全录音 启用设备是一种可用的低成本技术，允许患者单独或 与照顾者和家人分享。它已经在退伍军人事务部外进行了介绍和测试，有证据表明 增加患者的回忆和理解，甚至可能改善医生的表现。鲜为人知的是， 然而，关于这些影响是否以及在多大程度上导致了更好的结果，如改善 坚持治疗计划和慢性病自我管理。 意义/影响：这项研究将评估增强退伍军人理解能力的新资源 他们的护理计划，并与照顾者分享他们访问的信息。研究设计的目的是为了产生 为决策者提供信息，帮助他们了解向VHA提供“开放存取音频”(OAA)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 是一项重大创新，于2010年首次通过患者门户网站推出，并正在迅速传播-- 包括在VHA内部。高龄津贴延续了完全透明和方便获得医疗服务的相同原则 信息，如果成功，也可以合并到患者门户中。VHA办公室 管理MyHealtheVet的Connected Care已表示对此项目感兴趣，因为它具有潜力 改造下一代门户。 具体目标：这项研究将使用随机对照试验设计，获得 OAA(更好的患者回忆和理解)导致了几个所需的服务利用和医疗保健结果。它 还将衡量高龄津贴对可能调解这些结果的提供者行为的影响。在整个过程中，数据将 收集参与者和其他利益相关者对计划的看法，这些看法基于先前对音频- 在临床环境中记录，反映了采用新技术的准备情况。 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)和两项慢性条件措施(糖化血红蛋白、血压)。 二次分析将描述性地衡量急诊室就诊和住院人数的影响大小。 目标2：评估开放访问音频对提供商通信和他们对患者的关注的影响 背景因素(即退伍军人个人需求和与规划有效护理相关的情况)。 目标3：评估患者、提供者和领导层对该计划安全程度的看法，而不是 负担沉重，无论是在项目开始时还是在项目开始后的两年，都是值得的。 方法：设置初级保健和糖尿病诊所，在两个机构推广。至 为了实现目标1和目标2，我们提出了随机对照三臂设计：(1)记录相遇， 有了提供者和患者的感知，并上传到服务器上，老兵、提供者和研究团队可以 访问后访问；(2)在双方都知道的情况下记录相遇，并仅将 研究团队可以访问；以及(3)在只有患者知道的情况下记录遭遇，并上载到 只有研究团队才能访问服务器。目标1所示的资源利用和疾病措施 两个人将在所有的军队中被收集。武器“1”和“2”的比较使评估 为患者提供音频(目标1)。通过将ARM“2”与“3”进行比较，可以隔离 提供商知道他们正在被录音(对于AIM 2)。AIM 3的数据将来自调查工具、Focus 小组和半结构化的领导面谈，以引发对项目安全性、负担和价值的看法。 下一步/实施：我们将与互联健康办公室合作，寻找机会， 基于将Open Audio Access整合到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.