ConProject-002

ConProject-002

• 批准号: 10153872
• 负责人: Jared W. Magnani
• 金额: $ 26.2万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-27 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10153872
• 关键词: Address; Adherence; Advisory Committees; Anticoagulants; Anticoagulation; Atrial Fibrillation; Benchmarking; Black race; Cardiovascular Diseases; Cardiovascular system; Caring; Cellular Phone; Chronic; Chronic Disease; Clinic; Complement; Complex; Computer Literacy; Computers; Cues; Data; Disease Outcome; Education; Educational Curriculum; Electronic Health Record; Emergency Situation; Facial Expression; Gestures; Guidelines; Hand; Health; Health Educators; Health Promotion; Health Status; Health behavior outcomes; Health education; Health system; Heart Rate; Heart failure; Hospitalization; Incidence; Income; Individual; Information Systems; International; Intervention; Interview; Low income; Measurement; Measures; Medical Care Costs; Medical center; Modification; Monitor; Morbidity - disease rate; Myocardial Infarction; Outcome; Outcome Measure; Participant; Patient Care; Patient Outcomes Assessments; Patient Self-Report; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Prevalence; Preventive treatment; Problem Solving; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Research; Resources; Self Care; Self Efficacy; Speech; Stroke; Stroke prevention; Symptoms; System; Terminology; Testing; Universities; Visit; Voice; arm; base; clinical infrastructure; cohort; complex chronic conditions; cost; diaries; disabling symptom; efficacy evaluation; efficacy testing; ethnic minority population; experience; gaze; health application; health care service utilization; health literacy; health related quality of life; heart rhythm; high risk; improved; innovation; intervention effect; intervention participants; mHealth; medical specialties; member; mortality; novel; novel strategies; optimal treatments; patient oriented; primary outcome; programs; racial and ethnic; recruit; secondary outcome; skills; social; social determinants; social factors; social health determinants; socioeconomics; standard care; stroke risk; success; symptom treatment

Atrial fibrillation (AF) is a common, morbid condition. Symptoms, complex management, and significant adversity contribute to poor health-related quality of life (HRQoL). Social determinants of health exacerbate morbidity in AF, and limited health literacy compounds the poor patient experience of AF. We propose a single- center parallel group randomized clinical trial to test the efficacy of an embodied conversational agent (ECA) to improve patient-centered care in AF. The ECA is a computer character that simulates face-to-face conversation using voice, hand gesture, and gaze cues to provide education, monitoring and problem-solving. We have used the ECA in multiple health contexts for self-care and demonstrated its success to improve health behaviors and outcomes in individuals with limited computer and health literacy. Here we propose to expand our successful 30-day pilot (n=31) of the ECA and the AliveCor Kardia smartphone heart rate and rhythm monitor in order to evaluate the effect of a 4-month self-care curriculum and assess its 12-month sustainability. We will further test the integration of ECA/Kardia results in the electronic health record (EHR) and monitor alerts and resulting modifications to care. We will randomize 240 patients with AF who are receiving anticoagulation to either (1) the ECA/Kardia intervention, provided by smartphone, and accompanying EHR alerts, or (2) the control, consisting of an AF educational session, diary for recording symptoms and adherence, and a smartphone with a general health application for self-care (WebMD). Our trial will leverage the clinical infrastructure of the University of Pittsburgh Medical Center (UPMC) by recruiting at 8 UPMC clinics that share a common electronic health record. We will focus recruitment on individuals with limited socioeconomic resources, low health literacy, or racial/ethnic minorities. Our aims are: (1) To examine the effect of the ECA/Kardia intervention on patient-centered outcomes. We will evaluate HRQoL with the AF- specific AF Effect on QualiTy of life (AFEQT) measure and general HRQoL with the Patient-Reported Outcomes Measurement Information System-29 Profile at baseline, 4, and 12 months. (2) To evaluate the effect of the ECA/Kardia and EHR alert intervention on anticoagulant adherence. We will quantify adherence using medication possession ratio and pharmacy contact at 12 months, and complementary measures of self- reported non-adherence at baseline, 4, and 12 months. (3) To determine the effect of the intervention on health care utilization at 4 and 12 months using participant interview and the common EHR. Our trial will engage an 8- member patient advisory committee comprised of individuals with chronic AF to guide the intervention's cultural acceptability, recruitment, and presentation of results. Expected Results: In this project we will evaluate a scalable patient-centered intervention to improve HRQoL, improve anticoagulation adherence, and reduce health care utilization in vulnerable individuals with chronic AF. If proven successful, this intervention can be broadly disseminated to improve the care of patients with AF.

心房颤动（AF）是一种常见的病态状况。症状，复杂的管理和重要 逆境有助于健康相关的生活质量（HRQOL）。健康的社会决定因素加剧 AF的发病率和有限的健康素养使AF的患者经历差。我们提出了一个 中心平行组随机临床试验，以测试体现的对话剂（ECA）的功效 改善AF中以患者为中心的护理。 ECA是模拟面对面的计算机字符 使用语音，手势和凝视提示对话，以提供教育，监测和解决问题。 我们已经在多种健康环境中使用了ECA进行自我保健，并证明了其成功以改善 计算机和健康素养有限的个人的健康行为和结果。在这里我们建议 扩展我们成功的30天试点（n = 31）和Alivecor Kardia智能手机心率和 节奏监测器以评估4个月的自我护理课程的效果并评估其12个月 可持续性。我们将进一步测试ECA/Kardia的整合导致电子健康记录（EHR） 并监视警报和导致的修改以进行护理。我们将随机分配240名AF患者 接受抗凝（1）智能手机提供的ECA/KARDIA干预，以及 随附的EHR警报，或（2）控制，由AF教育会议组成，记录日记 症状和依从性，以及具有自我护理的一般健康应用（WebMD）的智能手机。我们的审判 将通过8点招募匹兹堡医学中心（UPMC）的临床基础设施（UPMC） 具有共同电子健康记录的UPMC诊所。我们将集中招聘 有限的社会经济资源，低健康素养或种族/族裔少数民族。我们的目标是：（1）检查 ECA/Kardia干预对以患者为中心的结果的影响。我们将通过AF-评估HRQOL 特定的AF对生活质量质量（AFEQT）的影响和患者报告的一般HRQOL 结果测量信息系统29在基线，4和12个月时。 （2）评估 ECA/Kardia和EHR警报干预对抗凝剂依从性的影响。我们将量化依从性 在12个月时使用药物拥有率和药房接触，以及自我的互补措施 报告的基线，4和12个月时不遵守。 （3）确定干预对健康的影响 使用参与者访谈和共同的EHR，在4和12个月时进行护理利用。我们的审判将参与8- 成员患者咨询委员会由患有慢性AF的人组成，以指导干预的文化 结果的可接受性，招聘和结果。预期结果：在这个项目中，我们将评估 可扩展的以患者为中心的干预措施以改善HRQOL，提高抗凝性粘附并减少 患有慢性AF的脆弱患者的医疗保健利用。如果被证明是成功的，则可以 广泛传播以改善AF患者的护理。