Leveraging mobile health technology to reduce avoidable healthcare utilization in persons with Alzheimer's Disease and Related Dementias in adult day centers

利用移动医疗技术减少成人日间中心阿尔茨海默病和相关痴呆症患者本可避免的医疗保健利用率

• 批准号: 10649808
• 负责人: Tina Sadarangani
• 金额: $ 5.18万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649808
• 关键词: Access to Information; Acute; Address; Adult; Alzheimer' s disease related dementia; Area; Behavior Therapy; Caregivers; Caring; Clinical; Communication; Communities; Dementia; Development; Distress; Early Diagnosis; Emergency Situation; Emergency department visit; Family; Future; Goals; Health; Health Status; Health Technology; Health system; Hospital Costs; Hospitalization; Integrated Health Care Systems; Intervention; Low income; Medical Records; Medical emergency; Mentored Patient-Oriented Research Career Development Award; Mentorship; Minor; Mobile Health Application; Notification; Outcome; Patients; Persons; Principal Investigator; Provider; Quality of Care; Registered nurse; Reporting; Research; Scientist; Services; Social Workers; Statutes and Laws; Symptoms; Testing; Time; Training; Treatment Efficacy; Visit; Visual; Work; acceptability and feasibility; behavior test; care providers; community based care; cost; design; disparity reduction; efficacy testing; experience; facsimile; health care delivery; health care service utilization; health care settings; health information technology; improved; informal caregiver; innovation; mHealth; programs; racial diversity; smartphone Application; user centered design

Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoidable emergency de- partment (ED) visits and hospitalizations. Adult day service centers (ADCs) provide community-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily assessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to com- municate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve com- munication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an independent scientist who leads a re- search program that integrates care from ADCs and PCPs using mHealth interventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to address health care utilization disparities, developing mHealth interventions using user-centered design principles, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) Identify patient and caregiver reported warning signs that can be integrated into an mhealth application in order to address emerging clinical problems and distressing symptoms among PLWD in ADCs; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and informal care- givers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth application use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6- month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve stand- ards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access infor- mation from their medical records using their preferred smartphone application. This study is innovative be- cause it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the development of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.

项目摘要。 居住在痴呆症（PLWD）的社区居民非常容易避免紧急情况 政党（ED）访问和住院。成人日间服务中心（ADC）为一个社区提供基于社区的护理 越来越多的大约潜水员PLWD，其中大多数是低收入的。日常评估和序列 ADC跨学科人员的观察（包括注册护士，社会工作者和计划 董事）支持PLWD中临床问题的早期检测。但是，当急性健康状况变化时 发生，希望向初级保健提供者（PCP）提供及时通知的ADC员工无法做到 如此有效。在我先前的研究中，我发现ADC的工作人员对传真或语音邮件的消息放心， 渠道紧急信息。这导致了PCP的延迟或非反应，并允许较小的健康 升级为医疗紧急情况的问题。随着ADC中PLWD的数量的增加，有一个迫切的需求 加强ADC，PCP和护理人员之间的显着临床信息的沟通，以减少 昂贵的住院和急诊就诊。已显示移动健康（MHealth）干预措施可改善 跨各种医疗机构的市政和临床信息交流 为ADC设计。我寻求K23奖的目标是成为一名独立科学家 使用MHealth干预措施从ADC和PCP集成护理的搜索程序，以减少可避免的 PLWD中的医疗保健利用差异。在经验丰富的跨学科指导的支持下 团队，我将在三个领域获得培训：使用集成的卫生系统来解决医疗保健利用 差异，使用以用户为中心的设计原理制定MHealth干预措施以及设计和测试 行为干预。通过必要的培训，我将执行以下特定目标：（1）确定患者 护理人员报告了可以集成到MHealth申请中以解决的警告信号 ADC中PLWD的新兴临床问题和令人痛苦的症状； （2）设计和测试视觉 MHealth应用程序的布局旨在支持ADC，PCP和非正式护理之间的通信 - 给予PLWD； （3）开发和检查MHealth应用程序使用的可行性和可接受性 在ADC工作人员，PCP和非正式护理人员中，在6--降低了PLWD的住院和ED访问中 月期。我的发现将为未来的R01提案提供信息，以测试使用全面的干预效率 运营MHealth应用程序。这项研究很重要，因为这些发现将用于改善独立 PLWD中的护理和减少昂贵和创伤的结果。它还从办公室的立法提升 国家卫生信息技术协调员，要求患者能够获得信息 使用他们首选的智能手机应用程序从他们的病历中进行介绍。这项研究是创新的 因为它利用ADC的优势，并结合了前线提供商的观点，以告知开发 务实的以用户为中心的MHealth应用程序，以整合PLWD中的护理并减少分布。