A Theory-Based Patient Portal eLearning Program for Older Adults with Chronic Illnesses

针对患有慢性病的老年人的基于理论的患者门户电子学习计划

• 批准号: 9167303
• 负责人: EUN-SHIM NAHM
• 金额: $ 17.21万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9167303
• 关键词: Theory; Based; Patient; Portal; eLearning

Project Summary/Abstract The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million adults age ≥50 have at least one chronic illness. Management of chronic conditions requires long-term use of complex treatment plans and can cause unintended consequences, such as increased risk of medication errors. Patient portals (PPs), a federally supported health information technology (IT), can be especially helpful for patients with chronic illnesses. Patients can now access their own health records and directly communicate with care providers through PPs. Prior findings suggest a great potential for using PPs to improve care quality, and the federal government funds healthcare organizations to implement this tool nationwide (Meaningful Use incentive payment program). Despite the potential benefits, the overall PP adoption rate in the U.S. is low (26.8% in a 2014 national survey). A lack of PP use among older adults has been addressed as a particular concern. When only older adults who use the Internet are considered, however, their proportion of PP use is similar to other age groups. A few studies also reported that older adults are receptive to PPs.In general, older adults need additional support for learning to use PPs for their care management, as they tend to be less familiar with technology. Currently, most older adults receive little or no PP support from their providers. This is an important gap in the nation’s health IT initiative because without appropriate support, older adults will not be able to use this robust health tool, missing an important opportunity to improve their health outcomes. In an effort to fill this gap, in our preliminary study, we developed and tested an older adult friendly Theory-based Patient portal eLearning Program (T-PeP) to support older adults in using PPs for their care. In the proposed feasibility study, we plan to (Aim 1) optimize and implement a vendor- agnostic T-PeP and conduct formative and process evaluations (e.g., usability, facilitators/barriers); and (Aim 2) assess the preliminary impact of T-PeP on PP use and selected outcomes (PP knowledge, self-efficacy for PP use and health decision making, health communication, and medication reconciliation). A two-arm RCT will be conducted with older adults who have chronic conditions (N=242, age ≥50) and are recruited online. Data will be collected at baseline, the end of treatment (3 wks), and 4 months. Appropriate analytic approaches will address each study aim, including descriptive statistics, linear mixed models, and qualitative analyses. If successful, this study could directly affect quality of care provided to older adults and the success of the national health IT initiative. Findings from this study will also provide hospitals, vendors, and policymakers with in-depth information on older adults’current PP usage patterns and other challenges in using various types of PPs at the national level, contributing to the advancement of PP technology and changes in practice. In the next phase of the R01 study, we will test its long-term effects on health behaviors and clinical outcomes (e.g., improvement HbA1c) using more diverse samples, including practice settings and underserved populations.

项目摘要/摘要 在美国，慢性病的高流行率是一个严重的公共卫生问题，超过70个 百万50岁的成年人至少患有一种慢性病。慢性病的管理需要长期 使用复杂的治疗计划并可能导致意外后果，例如增加的风险 用药错误。患者门户（PPS）是一种联邦支持的健康信息技术（IT），可以是 对患有慢性疾病的患者特别有用。现在，患者可以访问自己的健康记录， 直接通过PPS与护理提供者进行沟通。先前的发现表明，使用PPS具有很大的潜力 提高护理质量，联邦政府资助医疗组织来实施此工具 全国（有意义的使用激励付款计划）。尽管有潜在的好处，但总体PP 美国的采用率很低（2014年全国调查中的26.8％）。老年人缺乏PP使用 被认为是一个特别关注的问题。但是，只有考虑使用互联网的老年人就被考虑 他们的PP使用比例类似于其他年龄组。一些研究还报道了老年人是 接受PPS。总的来说，老年人需要额外的支持才能学习使用PPS进行护理 管理，因为它们往往不太熟悉技术。目前，大多数老年人几乎没有或没有 PP提供者的支持。这是国家健康的重要差距，因为没有 适当的支持，老年人将无法使用这种强大的健康工具，缺少重要的机会 改善他们的健康状况。为了填补这一空白，在我们的初步研究中，我们进行了开发和测试 基于老年人友好理论的老年患者门户网络学习计划（T-PEP），以支持老年人使用 PPS照顾他们。在拟议的可行性研究中，我们计划（目标1）优化和实施供应商 不可知论的T-PEP和进行形成和过程评估（例如，可用性，促进者/障碍）； （目标2） 评估T-PEP对PP使用和选定结果的初步影响（PP知识，PP的自我效能感 使用和健康决策，健康沟通和药物对帐）。两臂RCT将是 由患有慢性疾病的老年人（n = 242，年龄≥50）进行，并在网上招募。数据将 在基线，治疗末期（3周）和4个月时收集。适当的分析方法将 解决每个研究目标，包括描述性统计，线性混合模型和定性分析。如果 成功，这项研究可能直接影响提供给老年人提供的护理质量以及 国家健康IT计划。这项研究的发现还将为医院，供应商和政策制定者提供 有关老年人的PP使用模式的深入信息以及使用各种类型的其他挑战 国家一级的PPS，有助于PP技术的发展和实践变化。在 R01研究的下一阶段，我们将测试其对健康行为和临床结果的长期影响（例如， 改进HBA1C）使用更多的潜水员样本，包括练习环境和服务不足的人群。