Personalized Patient data and behavioral nudges to improve adherence to chronic cardiovascular medications

个性化的患者数据和行为提示，以提高对慢性心血管药物的依从性

• 批准号: 10448390
• 负责人: SHEANA S BULL
• 金额: $ 140.39万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448390
• 关键词: Acute myocardial infarction; Adherence; Artificial Intelligence; Atrial Fibrillation; Attention; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Body Weight decreased; Cardiac; Cardiovascular system; Cellular Phone; Chronic; Chronic Disease; Clinical; Colorado; Coronary Arteriosclerosis; Data; Decision Making; Diabetes Mellitus; Disease; Event; Goals; Health; Health Care Costs; Health Promotion; Health Technology; Health behavior; Health system; Healthcare Systems; Hospitalization; Hospitals; Human; Hyperlipidemia; Hypertension; Individual; Institutes; Integrated Delivery of Health Care; Intervention; Intervention Studies; Libraries; Measures; Medical center; Methods; Modification; Morbidity - disease rate; Outcome; Patient Education; Patient Noncompliance; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Phase; Pilot Projects; Population; Prevalence; Provider; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Research; Resolution; Resources; Self Management; Study Subject; System; Technology; Testing; Text Messaging; United States National Institutes of Health; Universities; base; behavior change; behavioral economics; blood pressure control; chatbot; copayment; cost; design; digital; evidence base; financial incentive; four-arm study; health care delivery; health care service utilization; implementation process; improved; individual response; medication compliance; medication nonadherence; mortality; primary outcome; programs; randomized trial; response; safety net; secondary outcome; smoking cessation; text messaging intervention; theories; treatment as usual

Abstract Our objective in this project is to employ population level pharmacy data and delivery of nudges via cell phone text messaging and artificially intelligent (AI) interactive chat bot to improve medication adherence and patient outcomes in 3 integrated healthcare delivery systems (HCS): University of Colorado Health System (UCHealth), VA Eastern Colorado Health Care System (VA), and Denver Health Medical Center (DH). We will identify patients with chronic cardiovascular (CV) conditions taking medications to treat hypertension, atrial fibrillation, coronary artery disease, diabetes and/or hyperlipidemia. We will leverage pharmacy refill data to identify episodes of non-adherence through gaps in medication refills and randomize individuals to 1 of 4 study arms when they have a first refill gap: 1) usual care; 2) generic text message reminder; 3) tailored and engaging text messages optimized to facilitate behavior change; or 4) optimized text messages plus a pre- programmed AI interactive chat bot designed to support identification and resolution of barriers to medication refill and adherence. In the UG3 phase (year 1), we will develop and program a theoretically informed technology-based (a) text message library and (b) chat bot content library using multiple and iterative N of 1 within subject studies to optimize content for a range of diverse patients. These outcomes will inform a pilot intervention to demonstrate feasibility of delivering the intervention and preliminary effects in all 3 HCS. We will also engage patient, provider and health systems stakeholders in designing, refining, and implementing the pilot intervention. In the UH3 phase (years 2-5), we will conduct a pragmatic patient-level randomized intervention across 3 HCS to improve adherence to chronic CV medications. We will evaluate the intervention using a mixed methods approach and apply the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. In addition, we will assess the context and implementation processes to inform local tailoring, adaptations and modifications, and eventual expansion of the intervention.

抽象的 我们在这个项目中的目标是利用人口水平的药房数据并通过手机提供推动 短信和人工智能 (AI) 交互式聊天机器人可改善用药依从性和患者 3 个综合医疗保健服务系统 (HCS) 的成果：科罗拉多大学医疗系统 (UCHealth)、VA 东科罗拉多医疗保健系统 (VA) 和丹佛健康医疗中心 (DH)。我们将 识别患有慢性心血管 (CV) 疾病并服用药物治疗高血压、心房颤动的患者 纤维颤动、冠状动脉疾病、糖尿病和/或高脂血症。我们将利用药房补充数据来 通过药物补充的间隙来识别不依从的情况，并将个体随机分配到 4 项研究中的一项 当手臂有第一次补充间隙时： 1) 常规护理； 2）通用短信提醒； 3）量身定制和 吸引经过优化的短信以促进行为改变；或 4) 优化的短信加上预 编程人工智能交互式聊天机器人，旨在支持识别和解决药物障碍 补充和坚持。在 UG3 阶段（第一年），我们将开发和编程一个理论上丰富的 基于技术的 (a) 文本消息库和 (b) 使用多重和迭代 N of 1 的聊天机器人内容库 在主题研究中，为一系列不同的患者优化内容。这些结果将告知飞行员 干预，以证明在所有 3 个 HCS 中实施干预的可行性和初步效果。我们将 还让患者、提供者和卫生系统利益相关者参与设计、完善和实施 试点干预。在 UH3 阶段（第 2-5 年），我们将进行务实的患者水平随机化研究 对 3 个 HCS 进行干预，以提高对慢性 CV 药物的依从性。我们将评估干预措施 使用混合方法并应用 RE-AIM（范围、有效性、采用、实施和 维护）框架。此外，我们将评估背景和实施流程，以告知当地 剪裁、调整和修改，以及最终扩大干预措施。

项目成果

Ethnic Minorities' Perceptions of COVID-19 Vaccines and Challenges in the Pandemic: A Qualitative Study to Inform COVID-19 Prevention Interventions.

少数族裔对 COVID-19 疫苗的看法和大流行中的挑战：一项为 COVID-19 预防干预措施提供信息的定性研究。

• 发表时间: 2022-11
• 影响因子: 3.9
• 作者: Zhou, Shuo;Villalobos, Jennifer Paola;Munoz, Alondra;Bull, Sheana
• 通讯作者: Bull, Sheana

Text Message Medication Adherence Reminders Automated and Delivered at Scale Across Two Institutions: Testing the Nudge System: Pilot Study.

短信用药依从性提醒在两个机构之间自动化并大规模发送：测试助推系统：试点研究。

• 发表时间: 2021-05
• 作者: Luong, Phat;Glorioso, Thomas J;Grunwald, Gary K;Peterson, Pamela;Allen, Larry A;Khanna, Amber;Waughtal, Joy;Sandy, Lisa;Ho, P Michael;Bull, Sheana
• 通讯作者: Bull, Sheana

Leave me out: Patients' characteristics and reasons for opting out of a pragmatic clinical trial involving medication adherence.

把我排除在外：患者的特征和选择退出涉及药物依从性的实用临床试验的原因。

• 发表时间: 2021-12-23
• 影响因子: 1.6
• 作者: Sandy, Lisa Caputo;Glorioso, Thomas J;Weinfurt, Kevin;Sugarman, Jeremy;Peterson, Pamela N;Glasgow, Russell E;Ho, P Michael
• 通讯作者: Ho, P Michael

Description of patient questions received by clinical pharmacists in the Nudge Study.

临床药剂师在助推研究中收到的患者问题的描述。

• 发表时间: 2023-09-07
• 作者: Marrs, Joel C;Orlando, Steven T;Saseen, Joseph J;Novins;Sandy, Lisa Caputo;Waughtal, Joy;Glorioso, Thomas J;Ho, P Michael
• 通讯作者: Ho, P Michael