Addressing Contextual Factors in Chronic Disease Management in Minority Older Adults through Photo-based Patient-Clinician Communication

通过基于照片的患者与临床医生沟通解决少数民族老年人慢性病管理中的背景因素

• 批准号: 10542753
• 负责人: Jane Jih
• 金额: $ 17.48万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-11 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542753
• 关键词: 2 arm randomized control trial; Address; Adult; Affect; African American; Aging; Aleurites; Area; Asian; Asian Americans; Award; Caring; Cellular Phone; Chinese; Chronic Disease; Clinic; Clinic Visits; Clinical; Communication; Communication Barriers; Development Plans; Diabetes Mellitus; Diet; Diet Habits; Disease Management; Disparity; Elderly; Feedback; Glucose; Goals; Health; Health system; Individual; Intervention; Knowledge; Latino; Linguistics; Mentors; Minority; Mission; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient-Centered Care; Patients; Persons; Pharmaceutical Preparations; Population; Primary Care; Procedures; Protocols documentation; Randomized; Research; Research Personnel; Self Management; Social support; Standardization; Structure; Technology; Testing; Training; Visit; Work; World Health Organization; acceptability and feasibility; arm; career; career development; comorbidity; contextual factors; design; enhancing factor; ethnic minority; experience; fall risk; health care disparity; health disparity; health equity; human centered design; implementation science; improved; improved outcome; member; multi-ethnic; multi-site trial; multidisciplinary; multiple chronic conditions; older patient; participant retention; patient oriented; patient-clinician communication; primary care clinic; primary care setting; racial minority; recruit; skills; tool; usability

PROJECT SUMMARY AND ABSTRACT By 2050, 42% of the older U.S. population will be racial/ethnic minorities. Older minorities bear a substantial burden of multiple chronic conditions (MCC) and receive poorer quality of chronic disease management. Patient-clinician communication barriers are important contributors to disparities in care and outcomes of MCC. In particular, clinical visit communication about the context of people’s lives (i.e., contextual factors such as medication use, dietary habits, fall risk and social support) optimally informs MCC management and is vital to delivering patient-centered care. Yet, few patient-clinician communication interventions have included diverse older adults with MCC, and most do not address the interactions of aging, MCC and contextual factors that enhance or reduce health. A common scenario is the minority older adult with diabetes and concurrent comorbid conditions. The burden of self-management tasks related to diabetes (e.g., checking glucose, taking medications, adhering to diet) while simultaneously following care plans for other conditions can be overwhelming, particularly when care plans do not account for the context of patients’ daily lived experiences. The overarching goal of this proposal is to overcome disparities in patient-clinician communication among older minorities with MCC by developing a patient-centered technology-based communication intervention called Photo+Care. The premise of Photo+Care is that a picture is worth a thousand words, meaning that photos can promote efficient information exchange and activate patients to communicate their lived experiences to their clinicians, so they can develop patient-centered care plans together. Using smartphone cameras as a tool, Photo+Care will elicit and integrate 4 contextual factors (medication use, dietary habits, fall risk and social support) into primary care for older minority adults with MCC. Photo+Care will consist of a patient component, comprising: 1) brief training on how to take photos using a smartphone; and 2) standardized, structured and open-ended prompts to guide what kind of photos to take to describe 1 of the 4 contextual factors. The clinician component includes brief training on: 1) how to respond to photos shared by patients; and 2) how to discuss contextual factors elicited by the photos. The patient-clinician component is when patients briefly share select photos with clinicians during a clinic visit. The career goal of the candidate, Dr. Jane Jih, is to be a leader in the national mission to achieve health equity and a research expert on health disparities among older adults. Her short-term goals are to gain additional skills necessary to develop and test patient-centered interventions that improve outcomes for multiethnic and linguistically diverse older adults. To support her career development, Dr. Jih has assembled an exceptional multidisciplinary mentoring team including Dr. Christine Ritchie, a geriatrician with MCC expertise and Dr. Tung Nguyen, a national leader in Asian American health. This award will advance knowledge of patient-centered approaches to enhance the care of older adults, and allow Dr. Jih to receive additional training to become a leader in disparities and aging research.

项目概要和摘要 到 2050 年，42% 的美国老年人口将属于少数族裔/族裔。 多种慢性病（MCC）的负担，慢性病管理质量较差。 患者与临床医生的沟通障碍是造成 MCC 护理和结果差异的重要因素。 特别是，关于人们生活背景的临床就诊沟通（即背景因素，例如 药物使用、饮食习惯、跌倒风险和社会支持）为 MCC 管理提供最佳信息，对于 然而，很少有患者与临床医生的沟通干预措施包括多样化的护理。 患有 MCC 的老年人，大多数都没有解决衰老、MCC 和背景因素之间的相互作用， 一种常见的情况是患有糖尿病并并发的少数老年人。 与糖尿病相关的自我管理任务的负担（例如检查血糖、服用药物） 药物治疗、坚持饮食），同时遵循针对其他情况的护理计划 压倒性的，特别是当护理计划没有考虑患者日常生活经历的背景时。 该提案的总体目标是克服老年人之间患者与临床医生沟通的差异 通过开发一种以患者为中心、基于技术的沟通干预措施（称为 照片+护理 照片+护理的前提是一图胜千言，也就是说照片可以 促进有效的信息交流并激活患者将他们的生活经历传达给他们的患者 Fortress，这样他们就可以使用智能手机摄像头作为工具共同制定以患者为中心的护理计划， Photo+Care 将引出并整合 4 个背景因素（药物使用、饮食习惯、跌倒风险和社交） 支持）纳入针对患有 MCC 的老年少数族裔的初级护理将包括患者部分， 包括：1) 关于如何使用智能手机拍照的简短培训；2) 标准化、结构化和 开放式提示，指导临床医生拍摄什么样的照片来描述 4 个背景因素中的一个。 该部分包括以下方面的简短培训：1）如何回应患者分享的照片；2）如何讨论； 照片引发的背景因素是患者短暂分享选择时的情况。 候选人 Jane Jih 医生的职业目标是成为该领域的领导者。 她是实现健康公平的国家使命和老年人健康差异研究专家。 短期目标是获得额外的必要技能来开发和测试以患者为中心的干预措施 改善多民族和多语言老年人的成果 为了支持她的职业发展， Jih 博士组建了一支出色的多学科指导团队，其中包括 Christine Ritchie 博士， 具有 MCC 专业知识的老年病学家和亚裔美国人健康领域的全国领导者 Tung Nguyen 博士荣获此奖项。 将增进对以患者为中心的方法的了解，以加强对老年人的护理，并允许 Jih 博士 接受额外的培训，成为差异和老龄化研究的领导者。