Primary Care eHealth Intervention for Improved Outcomes in Chronic Kidney Disease

初级保健电子健康干预可改善慢性肾脏病的预后

• 批准号: 9282609
• 负责人: Veronica Yank
• 金额: $ 16.74万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9282609
• 关键词: Adopted; Adoption; Adult; Advertisements; Advertising; Affect; Affective; American; Area; Behavior; Behavior Therapy; Behavioral; Biometry; Blood Pressure; Cellular Phone; Cholesterol; Chronic Disease; Chronic Kidney Failure; Clinical Pharmacology; Clinical Trials; Cognition; Conscious; Data; Development; Disease; Disease Management; Disease Progression; Dose; Education; Electronic Health Record; Electronic Mail; Enrollment; Epidemiology; Evaluation; Foundations; Glucose; Goals; Grant; Health; Health Knowledge, Attitudes, Practice; Health behavior change; Healthcare; Human; Human Resources; Individual; Intention; Intervention; Laboratories; Marketing; Medical; Medicine; Mentors; Meta-Analysis; Methodology; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Operating System; Outcome; Output; Patient Care; Patients; Pattern; Pharmaceutical Preparations; Pharmacologic Substance; Physicians; Plasma; Population; Primary Health Care; Process; Proteinuria; Randomized; Randomized Controlled Trials; Research; Risk Factors; Sales; Science; Secure; Social Marketing; Social Psychology; System; Techniques; Testing; Text; Training; Translational Research; Translations; Uncertainty; Unconscious State; United States National Institutes of Health; Validation; Work; Writing; arm; base; behavior change; behavioral health intervention; career; career networking; design; digital; eHealth; efficacy testing; efficacy trial; follow-up; group intervention; health care service organization; improved; improved outcome; patient oriented; patient population; primary care setting; primary outcome; psychologic; public health relevance; racial minority; research and development; responsible research conduct; secondary outcome; skills; social; systematic review; theories; treatment as usual

DESCRIPTION (provided by applicant): My career goal is a translational research career that improves care for patients with chronic kidney disease (CKD) treated in primary care settings. I want to develop and then test in a pilot randomized controlled trial (RCT) a theory-based electronic health ("eHealth") intervention sent with the intention of changing the behavior of patients and clinicians. The intervention will be comprised of multicomponent, multichannel (e- mail, text message, online video) materials designed to prompt adoption of effective medications. To accomplish these goals, I will take courses to expand my skill set-those on biostatistics, clinical trials, meta- analysis, human motivation, marketing techniques, psychological interventions, product design, and digital medicine. I will also greatly benefit from my mentoring team providing me with planned tutorials: 1) Dr. Stafford (primary mentor) on clinician prescribing patterns and education, epidemiological analyses, chronic disease management trials, conduct of responsible research, development and implementation of an integrated research agenda, career networking, and NIH grant writing, 2) Dr. Chertow (co-mentor) on optimal CKD management and the design and management of RCTs for patients with CKD, 3) Dr. Bero (co-mentor) on qualitative methodologies, clinical pharmacology, research synthesis, and translation of evidence into practice, and 4) Dr. Ma (co-mentor) on research with electronic health records, electronic behavioral interventions, and primary care-based trials. To accomplish the research plan, our team will adapt empirically supported content from three related areas of research-on pharmaceutical advertising, social marketing, and enhanced prescriber education. The content will be adapted within an integrated behavioral framework that will synergistically target the dual processing systems of human cognition, the conscious system that involves controlled and purposeful processing and the affective system that uses rapid, automatic processing. The patients we will enroll are those with moderate CKD who receive primary care at Stanford or the Palo Alto Medical Foundation but have not yet adopted indicated medications. During the formative research aim, we will develop the eHealth intervention using observational, systematic review, and qualitative approaches. During the evaluative research aim, we will test the intervention vs. usual care in a 2-arm pilot RCT with 50 patients/arm. The primary outcome will be a 4-point metric assessing control of risk factors for CKD progression (proteinuria, blood pressure, plasma glucose, cholesterol) at 12-month follow-up. The hypothesis is that the eHealth intervention group will achieve better CKD risk factor control than the usual care group. Secondary outcomes will include new prescriptions, CKD progression, and feasibility and process data. Data generated by the development and testing of the eHealth intervention will guide the design of a larger RCT in an R01 application and other related studies. The eHealth intervention has the potential to improve the health of millions of patients with CKD not yet receiving effective medications and to be expanded to related diseases.

描述（由申请人提供）：我的职业目标是转化研究职业，改善了在初级保健环境中接受治疗的慢性肾脏病（CKD）的护理。我想在一项试验随机对照试验（RCT）中开发然后测试一种基于理论的电子健康（“ EHealth”）干预措施，目的是改变患者和临床医生的行为。干预措施将由多组分，多通道（电子邮件，短信，在线视频）材料组成，旨在提示采用有效的药物。为了实现这些目标，我将参加课程，以扩大对生物统计学，临床试验，元分析，人类动机，营销技术，心理干预，产品设计和数字医学的技能。我也会从中受益匪浅 my mentoring team providing me with planned tutorials: 1) Dr. Stafford (primary mentor) on clinician prescribing patterns and education, epidemiological analyses, chronic disease management trials, conduct of responsible research, development and implementation of an integrated research agenda, career networking, and NIH grant writing, 2) Dr. Chertow (co-mentor) on optimal CKD management and the design and management of RCTs for patients with CKD, 3) Bero博士（Co-Incertor）关于定性方法论，临床药理学，研究综合和证据转化为实践，4）MA（Co-Incertor）（Co-Interor）对电子健康记录，电子行为干预和基于初级保健的试验的研究。为了完成研究计划，我们的团队将适应来自研究的药品广告，社交营销和增强处方者教育的三个相关领域的凭经验支持的内容。内容将在一个集成的行为框架中进行调整，该框架将协同针对人类认知的双重处理系统，即有意识的系统，该系统涉及受控和有目的的处理以及使用快速，自动处理的情感系统。我们将入学的患者是那些在斯坦福大学或帕洛阿尔托医疗基金会获得初级保健但尚未采用的药物的患者。在形成性研究的目标中，我们将使用观察性，系统评价和定性方法来开发eHealth干预措施。在评估研究目标中，我们将在2臂PILOT RCT中测试干预措施与常规护理，其中50名患者/ARM。主要结果将是在12个月的随访中评估CKD进展风险因素（蛋白尿，血压，血浆葡萄糖，胆固醇）的4分度量。假设是，与常规护理组相比，eHealth干预组将获得更好的CKD风险因素控制。次要结果将包括新的处方，CKD进程以及可行性和过程数据。 eHealth干预措施的开发和测试产生的数据将指导R01应用程序和其他相关研究中较大的RCT的设计。 EHealth干预措施有可能改善数百万CKD患者尚未接受有效药物的健康状况，并将扩展到相关疾病。