Bringing Health Home: Evaluation of a Residential-based Telehealth Care Coordination Intervention

将健康带回家：基于住宅的远程医疗协调干预的评估

基本信息

批准号：
10362274
负责人：
GEORGE J UNICK
金额：
$ 76.82万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-14 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10362274
关键词：
Acute Address Adherence Adoption Aftercare Android Appointment Biological Blood Pressure Bluetooth COVID-19 pandemic Cardiovascular Diseases Caring Chronic Clinical Clinical Data Communities Complex Computerized Medical Record Consumer Satisfaction Control Groups Data Data Reporting Development Devices Diagnosis Disease Distress Effectiveness Enrollment Evaluation Expenditure Feedback General Population Geography Glucose Health Health Professional Health Services High Prevalence Home Hospitalization Hypertension Individual Intervention Lead Life Expectancy Maryland Measures Medicaid Medical Medical Care Costs Medication Management Mental Health Methods National Institute of Mental Health Non-Insulin-Dependent Diabetes Mellitus Outcome Patient Outcomes Assessments Patient Self-Report Persons Pharmaceutical Preparations Pharmacological Treatment Pharmacy facility Phase Phase II Clinical Trials Population Preventive Primary Care Physician Primary Health Care Provider Psyche structure Psychiatric therapeutic procedure Psychiatrist Research Risk Sampling Schools Services Small Business Innovation Research Grant Social Work Social outcome Structure Substance abuse problem Suicide Surveys System Technology Telemedicine Testing Time Universities Visit Vulnerable Populations Weight acute care acute stress base behavioral adherence care coordination care systems community based care community based service community setting comorbidity comparison group cost design digital disparity reduction effectiveness measure effectiveness testing electronic data experience health care service utilization health service use hospitalization rates improved innovation interoperability medical appointment medication compliance physical conditioning programs recruit service coordination service delivery severe mental illness smart home standardize measure telehealth telemonitoring terrapin treatment group urgent care web app

项目摘要

Individuals suffering from Serious Mental Illnesses (SMI) are at risk for serious adverse health and social outcomes compared to the general population due to a high prevalence of chronic physical health disorders such as cardiovascular disease, hypertension, and Type II Diabetes, along with consequences of mental distress such as suicide, substance abuse, and acute stress. Comorbidity of medical and mental health issues in this population often lead to higher medical costs and adverse health outcomes. While pharmacological treatments exist for these conditions, they have limited effectiveness in SMI populations because: (1) up to 60% of individuals with SMI do not take their psychiatric or somatic medications as prescribed, (2) individuals with SMI have poorer clinical outcomes and experience high rates of hospitalizations, and (3) individuals with SMI experience worse care. Challenges in the management of these complex chronic health and mental health conditions have led to the development of intensive community-based service delivery programs. However, as currently structured these intensive in-person interventions have only had limited impact optimizing service delivery, and consequently on adherence to treatment and health outcomes. While in-person clinical contact in select situations is important, telehealth may serve as an effective and nimble intervention to help meet the high need for clinical intervention for SMI populations and particularly those with geographically limited-service access. Although research exists regarding the efficacy of telehealth with SMI populations, most of the existing interventions with this population have been designed for institutional settings, not community settings, because of barriers to adoption of telehealth such as limited access to digital technology, technical support difficulties and cost of necessary technology. The COVID-19 pandemic has underscored the need for developing effective telemedicine and telemonitoring technologies to serve the unique needs of this vulnerable population in community settings. This project builds on a successful Phase I SBIR project and ongoing Phase II clinical trial of the Medherent medication management platform. This study will test an expanded set of telehealth care-coordination services that can be used to address the broad health needs of individuals diagnosed with SMI living in community settings and supported by community mental health agencies. We will recruit 300 individuals, including 200 individuals currently using the device and 100 new users of the device. The study will test the existing Medherent platform and a set of extended services. Our key outcomes include acute service use, receipt of preventive and other health screenings, health outcomes and costs of services. The study will use a Stepped Wedge Design approach with a matched comparison group to identify potential benefits of the intervention.

患有严重精神疾病 (SMI) 的个人面临严重不良健康和健康问题的风险由于慢性身体疾病的患病率很高，与一般人群相比，社会结果健康疾病，如心血管疾病、高血压和 II 型糖尿病，以及自杀、药物滥用和急性压力等精神困扰的后果。该人群的医疗和心理健康问题往往会导致更高的医疗费用和不利的结果虽然针对这些病症存在药物治疗，但其效果有限。对 SMI 人群有效，因为：(1) 高达 60% 的 SMI 患者没有服用他们的药物按照规定服用精神科或躯体药物，(2) 患有 SMI 的个体临床表现较差结果和住院率较高，以及 (3) 具有 SMI 经历的个人这些复杂的慢性健康和心理健康的管理面临着更糟糕的挑战。各种条件导致了以社区为基础的密集服务提供方案的发展。然而，按照目前的结构，这些密集的面对面干预措施的影响有限优化服务提供，从而优化治疗依从性和健康结果。在某些情况下，面对面的临床接触很重要，远程医疗可以作为一种有效且灵活的干预措施有助于满足 SMI 人群对临床干预的高需求特别是那些在地理上服务访问受到限制的人，尽管存在关于该服务的研究。远程医疗对 SMI 人群的有效性，针对该人群的大多数现有干预措施是为机构环境而不是社区环境设计的，因为采用障碍远程医疗，例如数字技术的获取有限、技术支持困难和成本 COVID-19 大流行凸显了提高有效性的必要性。远程医疗和远程监控技术，以满足这一弱势群体的独特需求该项目建立在成功的第一阶段 SBIR 项目和正在进行的第二阶段的基础上。 Medherent™ 药物管理平台的临床试验本研究将测试扩展的范围。一套远程医疗保健协调服务，可用于满足广泛的健康需求被诊断患有 SMI 的个人生活在社区环境中并得到社区精神支持我们将招募 300 名个人，其中包括目前使用该设备的 200 名个人。该研究将测试现有的 Medherent 平台和一组设备的 100 名新用户。我们的主要成果包括紧急服务使用、预防性服务和其他服务的接受。健康检查、健康结果和服务成本该研究将使用阶梯楔形。设计方法与匹配的对照组以确定干预措施的潜在益处。