A Mobile Relational Agent to Enhance Atrial Fibrillation Self-care

增强心房颤动自我护理的移动关系代理

• 批准号: 10153869
• 负责人: Jared W. Magnani
• 金额: $ 96.95万
• 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/10153869
• 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

PROJECT SUMMARY 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.

项目概要 心房颤动 (AF) 是一种常见的病态。症状、管理复杂且意义重大 逆境会导致健康相关的生活质量 (HRQoL) 较差。健康的社会决定因素加剧 房颤的发病率和有限的健康素养加剧了房颤患者的不良体验。我们提出一个单一的 中心平行组随机临床试验，测试实体对话代理 (ECA) 的功效 改善以患者为中心的 AF 护理。 ECA是一个模拟面对面的计算机角色 使用声音、手势和目光线索进行对话，以提供教育、监控和解决问题。 我们已在多种健康环境中使用 ECA 进行自我护理，并证明其成功改善 计算机和健康素养有限的个人的健康行为和结果。在此我们建议 扩大我们成功的 30 天 ECA 和 AliveCor Kardia 智能手机心率试点 (n=31) 节律监测器，以评估 4 个月的自我护理课程的效果并评估其 12 个月的效果 可持续性。我们将进一步测试 ECA/Kardia 结果在电子健康记录 (EHR) 中的集成 并监控警报和由此产生的护理修改。我们将随机抽取 240 名 AF 患者，他们是： 接受抗凝治疗 (1) 通过智能手机提供的 ECA/Kardia 干预，以及 随附的 EHR 警报，或 (2) 控制，包括 AF 教育课程、记录日记 症状和依从性，以及带有一般健康自我护理应用程序 (WebMD) 的智能手机。我们的审判 将利用匹兹堡大学医学中心 (UPMC) 的临床基础设施，在 8 日进行招募 共享共同电子健康记录的 UPMC 诊所。我们将重点招聘具有以下特点的个人： 社会经济资源有限、健康素养低或种族/族裔少数。我们的目标是： (1) 检验 ECA/Kardia 干预对以患者为中心的结果的影响。我们将使用 AF- 来评估 HRQoL 特定 AF 对生活质量的影响 (AFEQT) 测量和一般 HRQoL 与患者报告 结果测量信息系统-29 基线、4 个月和 12 个月的概况。 (2) 评估 ECA/Kardia 和 EHR 警报干预对抗凝治疗依从性的影响。我们将量化遵守情况 使用 12 个月时的药物持有率和药房接触情况，以及自我管理的补充措施 报告在基线、4 个月和 12 个月时未遵守规定。 (3) 确定干预措施对健康的影响 使用参与者访谈和通用 EHR 评估 4 个月和 12 个月时的护理利用情况。我们的试验将涉及 8- 由慢性房颤患者组成的患者咨询委员会成员，指导干预措施的文化 可接受性、招募和结果的呈现。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，提高抗凝依从性，并减少 患有慢性房颤的弱势个体的医疗保健利用。如果证明成功，这种干预措施可以 广泛传播以改善 AF 患者的护理。