Leveraging Heath Information Technology to Improve Post-Discharge Management for Patients with Heart Failure

项目摘要 我的长期职业目标是成为一名临床医生调查员，利用健康信息技术(IT) 改善有社会需求的患者的心血管结局。本应用程序的研究目标是 使用卫生信息技术减少健康素养低的患者因心力衰竭(HF)而再次住院的可能性 结合了行为科学和可用性测试。健康的社会决定因素(SDH)帐户 对于80%的健康结果，社会需求与较差的健康结果相关，包括30天 重新入院。满足个人的社交需求与改善临床结果有关，但 可能需要更长的时间才能有效地减少30天的重新入院。健康素养，它衡量的是 患者发现、理解和使用信息和服务的能力，以告知与健康相关的决定和 为自己和他人采取的行动，与患者的健康结果有关。健康素养低是很常见的 在心力衰竭患者中，并导致心力衰竭的管理不善。现有的干预措施，如患者 导航仪和讲义已被成功地用于改善健康状况较差患者的医疗保健 扫盲，但它们是间歇性的和资源密集型的。卫生信息技术工具的使用，如个性化、 基于文本消息的自动化应用程序，可用于住院后护理。我们的初步研究 表明使用该应用程序的心力衰竭患者与使用该应用程序的患者相比，再次住院30天的时间减少了 未使用该应用程序的心衰患者。然而，使用 由于低摄取率和高磨损率，其应用一直受到限制。建议的总体目标是 研究项目是纳入Nudge，并解决障碍，以改善患者对该应用程序的使用，以及 进行试点随机对照试验(RCT)以评估该应用程序在缩短30天中的使用情况 重新入院。我们将进行定性工作，以深入了解如何适应现有的短信 在健康素养较低的患者中改善其使用情况的干预措施(目标1)，进行可用性测试和 反复修订应用程序(目标2)，并进行试点RCT，以评估可接受性、可行性、 使用行为干预增加心力衰竭患者应用的初步效果 出院后(目标3)。来自这个职业发展指导奖的培训将提供四项技能 领域：1)行为科学；2)实施科学；3)健康素养；4)随机对照试验的设计和实施。 建议的研究活动以及培训和指导计划将为我的 作为一名独立临床医生调查员的职业。

Project Summary My long-term career goal is to become a clinician investigator, who uses health information technology (IT) to improve cardiovascular outcomes among patients with social needs. The research goal of this application is to use health IT to reduce preventable readmissions for heart failure (HF) among patients with low health literacy with the incorporation of behavioral science and usability testing. Social determinants of health (SDH) account for 80% of health outcomes, and social needs are associated with poor health outcomes, including 30-day readmissions. Addressing individuals’ social needs has been associated with improved clinical outcomes, but may take a prolonged time to effectively reduce 30-day readmissions. Health literacy, which measures a patient’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, is associated with patients’ health outcomes. Low health literacy is common among patients with HF, and leads to poor management of HF. Extant interventions, such as patient navigators and handouts, have been utilized successfully to improve medical care for patients with low health literacy, but they are episodic and resource-intensive. The use of health IT tools, such as a personalized, automated text-message-based application, can be utilized for post-hospitalization care. Our preliminary study indicates that patients with HF who use this application had reduced 30-day readmissions, compared to patients with HF who did not use the application. However, the number of patients with HF using the application has been limited, due to low uptake and high attrition rate. The overall objective of the proposed research project is to incorporate nudges, and address barriers to improve patients’ use of the application, and conduct a pilot randomized controlled trial (RCT) to evaluate the application’s use in reducing 30-day readmissions. We will conduct qualitative work to gain insights into how to adapt an extant text messaging intervention to improve its use among patients with low health literacy (Aim 1), conduct usability testing and iterative revision of the application (Aim 2), and conduct a pilot RCT to evaluate the acceptability, feasibility, and preliminary efficacy of using behavioral interventions to increase the application use for patients with HF post-discharge (Aim 3). The training from this mentored career development award will provide skills in four domains: 1) behavioral science; 2) implementation science; 3) health literacy; and 4) RCT design and conduct. The proposed research activities, and the training and mentoring plans will provide the foundation for my career as an independent clinician investigator.