Implementation Outcomes of a Health IT Program For Vulnerable Diabetes Patients

描述(申请人提供)：糖尿病是一个主要的公共卫生问题，对弱势群体的影响不成比例，包括种族和民族少数群体、社会经济地位较低的人和健康素养较低的个人。我们建议评估为慢性病患者实施创新的健康信息技术(Health IT)干预的保真度，自动电话支持计划(ATSM)是为接触糖尿病易感人群而开发的。我们已经在疗效和有效性试验中开发和研究了ATSM，发现ATSM与多种糖尿病相关结局的改善有关。ATSM受到了全国的关注，并与国家医疗改革政策保持一致，重点是确定如何最好地部署医疗信息技术，以低成本向美国人口的大部分部门提供有效的医疗服务。基于日益增长的兴趣，审查与ATSM实施相关的因素可能会影响其更广泛的采用是至关重要的。ATSM是一种复杂的干预措施，它利用电话技术提供患者监控和教育，并为最有需要的人确定进一步的电话护理管理工作的优先顺序。ATSM的创新与其相关：(1)将电子信息整合到正在进行的临床护理中，以提高提供护理的质量和效率；(2)由护理经理通过电话进行有效的健康沟通，以提供识字或根据语言定制的支持咨询。我们在“真实世界”实施研究中向ATSM提供了AHRQ资助，并与区域卫生计划--旧金山卫生计划(SFHP)建立了伙伴关系。我们建议在本R03中审查干预措施实施的保真度，并审查为增加其采用率而进行的调整。具体地说，我们将使用改进的概念框架来评估实施忠诚度，以组织基本的ATSM交付组件。我们将使用这个框架来构建基于数据的详细评估，以评估保真度指标(例如，ATSM交付的频率、内容和持续时间)，以及与ATSM交付的拟议调节因素相关的度量(例如，参与者和非参与者的代表性，以及护理管理呼叫的质量)。我们将与SFHP合作，分析为ATSM计划收集的大量数据，并开发一份用户指南，为考虑扩大类似卫生IT干预措施的其他组织提供参考。关于如何使复杂的卫生信息技术干预措施(如ATSM)适应当地卫生系统需求的文献很少。审查此类计划实施的保真度，描述为促进采用而进行的调整，并检查调整和主持人将如何提供相关的必要信息。这些发现可以推动糖尿病护理领域的发展，及时提供对实施规划至关重要的采用过程的信息，并作为评估其他复杂的卫生信息技术干预措施的模型。R03作为开发证据基础的重要组成部分，为ATSM等医疗信息技术创新的扩大提供信息。 与公共卫生的相关性：糖尿病是一个主要的公共卫生问题，对弱势群体的影响不成比例，包括种族和族裔少数群体、社会经济地位较低的群体和健康素养较低的个人。我们已经开发并发现在功效研究方面取得了成功，这是一种针对患者语言和识字需求量身定做的医疗IT创新，并正在完成一项关于其有效性的研究，该研究采用了当地的医疗补助管理保健计划，进行了一项“真实世界”的翻译研究试验。我们建议在本R03中审查干预措施实施的保真度，并审查为增加采用而进行的调整。这些信息可以为国家医疗改革中正在进行的努力提供信息，这些努力旨在扩大医疗信息技术干预，以抵消日益增长的慢性病护理成本。

DESCRIPTION (provided by applicant): Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We propose to evaluate the fidelity of implementation of an innovative health information technology (Health IT) intervention for patients with chronic disease, the Automated Telephone Support Program (ATSM) developed to reach vulnerable populations with diabetes. We have developed and studied ATSM in efficacy and effectiveness trials, finding ATSM is associated with improvements in multiple diabetes-related outcomes. ATSM has received national attention, and is aligned with the national health care reform policy focus on determining how best to deploy health IT to deliver effective health care at low cost to large sectors of the US population. Based on the growing interest, it is critical to examine factors associated with ATSM implementation that may impact its wider adoption. ATSM is a complex intervention that employs phone technology to provide patient surveillance and education and to prioritize further telephone care management efforts for those most in need. ATSM innovation relates to its: (1) integration of electronic information into ongoing clinical care, to improve quality and efficiency of care delivery; and (2) effective health communication tailoring, by care managers over the telephone, for the provision of literacy or language-tailored support counseling. We have provided ATSM in a 'real world' implementation study, with AHRQ funding, in partnership with a regional health plan, the San Francisco Health Plan (SFHP). We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase its adoption. Specifically, we will use a modified Conceptual Framework for Evaluating Implementation Fidelity to organize essential ATSM delivery components. We will use this framework to structure a detailed data-based assessment of fidelity measures (e.g. frequency, content, and duration of ATSM delivery), and measures related to proposed moderating factors to ATSM delivery (e.g. representativeness of participants vs. non- participants, and quality of care management calls). We will work with SFHP to analyze the extensive data collected for the ATSM program, and to develop a User Guide that may inform other organizations considering scaling up similar health IT interventions. There is scant literature on how to adapt complex health IT interventions, such as ATSM, to local health systems needs. Examining the fidelity of implementation of such a program, describing adaptations that were made to improve adoption, and examining how adaptations and moderators will provide relevant necessary information. These findings can move forward the field of diabetes care, provide timely information on processes of adoption critical to implementation planning, and serve as a model for evaluating other complex health IT interventions. This R03 serves as an essential component to developing an evidence base to inform the scaling up health IT innovations such as ATSM. PUBLIC HEALTH RELEVANCE: Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We have developed and found successful in efficacy studies, a health IT innovation that is tailored to patient language and literacy needs, and are completing a study of its effectiveness in a 'real world' translational research trial, with a local Medicaid managed care plan. We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase adoption. This information can inform efforts underway in national health reform, to scale up health IT interventions to off-set growing chronic disease care costs.