Using artificially intelligent text messaging technology to improve American Heart Association's Life's Simple 7 Health Behaviors: LS7 Bot + Backup

利用人工智能短信技术改善美国心脏协会的生活简单7个健康行为：LS7 Bot Backup

• 批准号: 10649884
• 负责人: SHEANA S BULL
• 金额: $ 79.63万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10649884
• 关键词: Adherence; Advocate; Affect; American Heart Association; Architecture; Artificial Intelligence; Attention; Authorization documentation; Behavior; Behavioral; Black race; Blood Glucose; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Categories; Cellular Phone; Cessation of life; Cholesterol; Chronic; Chronic Disease; Clinic; Clinical; Colorado; Communication; Communities; Competence; County; Data; Data Collection; Decision Making; Diabetes Mellitus; Diet; Disparity; Electronic Health Record; Eligibility Determination; Emerging Technologies; Enrollment; Equity; Family health status; Federally Qualified Health Center; Focus Groups; Future; Goals; Group Interviews; Health; Health Care Costs; Health Personnel; Health Services Accessibility; Health behavior; Health behavior change; Health system; Healthcare Systems; Hispanic; Hospitalization; Hospitals; Hypertension; Improve Access; Individual; Infrastructure; Intervention; Intervention Studies; Intuition; Latino; Lead; Learning; Life; Life Style; Limited English Proficiency; Location; Low income; Methods; Morbidity - disease rate; Myocardial Infarction; Neighborhood Health Center; Outcome; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Phase; Physical activity; Pilot Projects; Population; Prevention program; Provider; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Risk; Risk Factors; Role; Sampling; Self Care; Self Efficacy; Self Management; Smoking; Social Environment; Target Populations; Technology; Testing; Text Messaging; Update; Weight; authority; cardiovascular disorder risk; cardiovascular risk factor; chatbot; clinical care; comparative effectiveness; contextual factors; disorder control; effectiveness outcome; ethnic minority; evidence base; experience; health care service utilization; health disparity; health equity; healthy lifestyle; implementation framework; implementation outcomes; improved; innovative technologies; intervention delivery; intervention mapping; intervention refinement; lifestyle factors; medication compliance; patient engagement; patient population; population based; pragmatic randomized trial; primary outcome; programs; randomized trial; rural patients; safety net; social culture; social health determinants; sociocultural determinant; text messaging intervention; theories; trial design

PROJECT SUMMARY/ABSTRACT Our goal is to improve control of cardiovascular (CV) disease risk factors using a multilevel intervention leveraging cellphone-based text messages integrated within health systems to improve control of American Heart Association’s Life’s Simple 7 (LS7) lifestyle factors (blood glucose, cholesterol, blood pressure, physical activity, weight, diet, and smoking). When uncontrolled, these lifestyle factors lead to common co-existing chronic conditions (e.g., hypertension, diabetes), morbidity, health care costs and death. Patients who experience health disparities (i.e., ethnic minorities, those with limited English proficiency and those with low- income) are disproportionately affected by CV diseases, have worse disease control and suffer greater sequelae. Self-management is an individual’s role in managing chronic disease and has strong evidence of benefit. It includes self-care, lifestyle changes (e.g., increase physical activity), taking medications as prescribed and managing exacerbations of chronic condition(s). Text messaging interventions have improved health behaviors including physical activity and medication adherence. Incorporating behavioral “nudges,” defined as a small change in choice architecture that “alters people’s behavior in a predictable way” into text messages may further augment its impact. Behavioral nudges are more personalized, resonate better with patients, and have changed health behaviors. However, text message interventions have typically not been delivered to large samples, focused on patients experiencing health disparities, nor leveraged health system electronic health record (EHR) data to personalize content and maximize scale, reach and impact of messages. Using a patient-level randomized pragmatic trial, we will test the comparative effectiveness of 3 text messaging delivery strategies: 1) generic text messages; 2) interactive AI chatbot text messaging leveraging evidenced- based communication strategies with attention to patient context and sociocultural factors influencing self- management; or 3) interactive AI chatbot text messaging plus proactive pharmacist management. We plan to enroll 6,000 patients from clinics within 3 health systems that care for large populations experiencing health disparities: 1) Denver Health and Hospital Authority, 2), Salud Family Health Centers and 3) STRIDE Community Health Center. We will use health system EHR data to identify eligible patients, deliver the intervention, and assess patient-centered outcomes. The study findings will provide evidence regarding the best population-based strategy for universal delivery to engage all patients with health disparities in self- management to improve the AHA’s LS7. The intervention will be delivered in real world settings to augment routine clinical care and improve access to care. We will incorporate lessons learned from one health system into adaptations for the other health systems in the study.

项目概要/摘要 我们的目标是通过多层次干预来改善对心血管 (CV) 疾病危险因素的控制 利用卫生系统中集成的基于手机的短信来改善对美国人的控制 心脏协会的 Life’s Simple 7 (LS7) 生活方式因素（血糖、胆固醇、血压、身体状况） 如果不加以控制，这些生活方式因素会导致常见的共存。 慢性病（例如高血压、糖尿病）、发病率、医疗费用和死亡。 经历健康差异（即少数族裔、英语水平有限的人和英语水平较低的人） 收入）受到心血管疾病的影响不成比例，疾病控制能力较差，遭受的痛苦更大 后遗症。 自我管理是个人在管理慢性病方面的作用，并且有强有力的证据表明其有益。 包括自我护理、改变生活方式（例如增加体力活动）、按处方服用药物和 控制慢性病的恶化 短信干预措施改善了健康行为。 包括身体活动和药物依从性，其中包括行为“推动”，定义为小规模。 将“以可预测的方式改变人们的行为”的选择架构改变为短信可能 进一步增强其影响力，行为推动更加个性化，与患者产生更好的共鸣，并且具有 然而，短信干预措施通常不会传递给大规模人群。 样本，重点关注经历健康差异的患者，也没有利用卫生系统电子健康 记录 (EHR) 数据以个性化内容并最大限度地提高消息的规模、覆盖范围和影响力。 使用患者级别的随机实用试验，我们将测试 3 种短信的比较有效性 传递策略：1) 通用短信；2) 交互式人工智能聊天机器人短信，利用证据- 基于沟通策略，关注患者背景和影响自我的社会文化因素 管理；或 3）交互式人工智能聊天机器人短信加上主动药剂师管理。 招收来自 3 个医疗系统内诊所的 6,000 名患者，这些系统为大量健康人群提供护理 差异：1) 丹佛健康和医院管理局，2) Salud 家庭健康中心和 3) STRIDE 我们将使用卫生系统 EHR 数据来识别符合条件的患者，并提供社区卫生中心。 干预，并评估以患者为中心的结果。研究结果将提供有关的证据。 最佳的基于人群的普遍实施战略，让所有健康状况存在差异的患者参与自我治疗 管理层将改进 AHA 的 LS7。干预措施将在现实环境中进行，以增强效果。 常规临床护理并改善获得护理的机会 我们将吸收从一个卫生系统吸取的经验教训。 适应研究中的其他卫生系统。