Personal Health Record-Facilitated Diabetes Self-Management Among Rural Veterans

个人健康记录促进农村退伍军人的糖尿病自我管理

• 批准号: 8675999
• 负责人: Cheryl P Lynch
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8675999
• 关键词: Accounting; Adherence; Adopted; Adoption; Adult; Age; Ambulatory Care Facilities; Behavior; Behavior Therapy; Behavior monitoring; Behavioral; Blindness; Cardiovascular Diseases; Caring; Catchment Area; Chronic Disease; Clinical Skills; Cognitive; Communication; Communities; Complex; Data; Data Sources; Development; Diabetes Mellitus; Diagnosis; Diet; Diet and Nutrition; Disadvantaged; Disease; Disease Management; Eating; Education; Educational Background; Educational process of instructing; Effectiveness; Enrollment; Ensure; Fatty acid glycerol esters; Fostering; Frequencies; Goals; HIV; Health; Health Services; Health Services Accessibility; Health Status; Healthcare; Healthcare Systems; Heart Diseases; Hepatitis C; Hyperlipidemia; Hypertension; Improve Access; Individual; Internet; Intervention; Interview; Kidney Failure; Knowledge; Learning; Learning Module; Life; Lower Extremity; Methods; Modality; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Participant; Patient Care; Patient Education; Patient Self-Report; Patients; Personal Health Records; Persons; Pharmaceutical Preparations; Physical activity; Pilot Projects; Population; Prevalence; Process; Provider; Quality of Care; Reporting; Research; Research Priority; Resources; Rest; Risk Factors; Rural; Sampling; Secure; Self Care; Self Efficacy; Self Management; Services; Solutions; Stroke; Structure; Technology; Telephone Interviews; Testing; Training; Ursidae Family; Veterans; base; cardiovascular disorder risk; cost effective; diabetes management; eHealth; empowerment; experience; flexibility; follow-up; health record; high risk; improved; limb amputation; medication compliance; patient oriented; post intervention; primary outcome; rural area; satisfaction; secondary outcome; skills; skills training; tool

Anticipated Impacts on Veterans Health Care: The proposed project offers a potential solution to strengthening Veterans' self-management of chronic disease conditions through intervention to an easily accessible, self-management tool, the VA's PHR - My HealtheVet that fosters the knowledge and skill-building aspects of diabetes self-management. The proposed approach creates flexible and accessible strategies for increasing knowledge, developing self-monitoring skills, building self-efficacy and enhancing patient empowerment. Thus, active orientation to the use of MHV as a skill-building tool will foster adoption of proper self-monitoring behaviors. The proposed project serves to yield a more patient-oriented process in access to and quality of care, and disease management. Furthermore, this project will provide early evidence to increase adoption and use of MHV in disadvantaged Veteran groups. Background: Veterans bear a disproportionate burden of diagnosed diabetes at a 24% prevalence compared to 8.3% nationally. Patient-level factors account for >95% of patient care and health management. Poor patient knowledge/information and participation are two key factors responsible for the most prevalent disparities in the VA healthcare system for which patient activation and adherence interventions may help to reduce disparities in care, but patients have a low rate of engagement in self-care behaviors. Healthcare systems have established personal health records (PHRs), such as My HealtheVet (MHV), that enable patients to access their own health records, obtain health information, and communicate with providers about their disease conditions. This study proposes to activate patients and improve patient diabetes-related behaviors through development of an adapted brief MHV-driven patient activation and self-care intervention that enhances DSM skills (e.g., physical activity, diet, medication adherence, and self-monitoring) in high-risk, rural Veterans. Objectives: The objectives of this study are to: (a) Adapt a brief My HealtheVet (MHV) intervention to enhance its appropriateness for Veterans with diabetes increase patient activation and DSM skills; (b) test feasibility and preliminary effectiveness of the adapted brief MHV intervention on DSM skills in rural Veterans; and (c) evaluate Veterans' experience with the adapted brief MHV intervention and identify perceived barriers, facilitators, and enablers of its use, and assess the potential for wider dissemination. Methods: To achieve these objectives, we will develop an adapted brief MHV intervention that targets DSM skills. Training for features of My HealtheVet (setting goals, entering/tracking data, researching health-related information, secure messaging) will first be developed. We will obtain a nonrandomized sample of at least 20 rural Veterans, age 45+ years, with diabetes and either hypertension or hyperlipidemia from community- based outpatient clinics in the Charleston VA catchment area. The intervention will involve an initial in-person session with the rest of intervention sessions delivered remotely. In addition, weekly reminders (or booster messages) will be sent to each participant through the MHV secure messaging. All participants will undergo assessments at baseline and at 6 weeks follow-up. For those who agree, semi-structured telephone interviews will be conducted with study participants to evaluate Veterans' experience with learning and navigating MHV through the intervention and to assess feasibility, ease of use, and refinement for potential dissemination to a broader audience. Primary outcomes, frequency of and satisfaction with MHV use, and secondary outcomes, change in DSM skills and clinical indicators, will be assessed in all participants at baseline and at 6 weeks follow-up. Quantitative analysis will involve rate of adoption and mixed effects models. The primary qualitative analysis will involve cognitive interviewing and discourse analysis of semi-structured interviews.

对退伍军人卫生保健的预期影响：拟议的项目为您提供了潜在的解决方案 通过干预来加强退伍军人对慢性疾病状况的自我管理 可访问的自我管理工具，VA的PHR-促进知识和技能建设的我的Healthevet 糖尿病自我管理方面。提出的方法为 提高知识，发展自我监控技能，建立自我效能并增强患者的知识 授权。因此，积极地取向使用MHV作为技能建设工具将促进采用适当的 自我监控行为。拟议的项目用于产生一个更面向患者的过程以访问 和护理质量和疾病管理。此外，该项目将提供早期证据以增加 在不利的退伍军人团体中采用和使用MHV。 背景：退伍军人在24％的患病率下承担诊断糖尿病的负担不成比例的负担 全国8.3％。患者级因素占患者护理和健康管理的95％。病人不好 知识/信息和参与是导致最普遍差异的两个关键因素 患者激活和依从性干预措施的VA医疗保健系统可能有助于减少 护理方面的差异，但患者参与自我保健行为的比率较低。医疗保健系统具有 建立的个人健康记录（PHR），例如我的Healthevet（MHV），使患者能够访问 他们自己的健康记录，获取健康信息，并与提供者就其疾病进行沟通 状况。这项研究建议通过 开发改编的简短MHV驱动的患者激活和自我保健干预措施，从而增强DSM 高危农村退伍军人的技能（例如体育锻炼，饮食，药物依从性和自我监控）。 目的：本研究的目标是：（a）简要介绍我的Healthevet（MHV）干预措施 增强对糖尿病退伍军人的适当性，提高患者的激活和DSM技能； （b） 测试改编的简短MHV干预DSM技能的可行性和初步效果 退伍军人； （c）评估退伍军人对改编的简短MHV干预的经验，并确定 感知到其使用的障碍，促进者和推动因素，并评估了更广泛的传播的潜力。 方法：为了实现这些目标，我们将开发针对DSM的改编的简短MHV干预措施 技能。培训我的Healthevet功能（设定目标，输入/跟踪数据，研究与健康有关的 信息，安全消息传递）将首先开发。我们将获得至少的非随机样本 20名农村退伍军人，45岁以上，患有糖尿病以及社区的高血压或高脂血症 - 位于查尔斯顿VA集水区的门诊诊所。干预措施将涉及最初的面对面 与其余干预会议的会议进行了远程交付。此外，每周提醒（或助推器 消息）将通过MHV安全消息发送给每个参与者。所有参与者都会经历 基线和6周的随访时进行评估。对于那些同意的人，半结构化的电话采访 将与研究参与者一起评估退伍军人学习和导航MHV的经验 通过干预并评估可行性，易用性和细化，以便将其传播到 更广泛的受众。主要结果，对MHV使用的频率和满意度以及次要结果， DSM技能和临床指标的变化将在基线和6周的所有参与者中进行评估 后续。定量分析将涉及采用率和混合效应模型。主要定性 分析将涉及半结构化访谈的认知访谈和话语分析。