Using Smart Displays to Implement an Evidence-Based eHealth System for Older Adults with Multiple Chronic Conditions

使用智能显示器为患有多种慢性病的老年人实施循证电子医疗系统

• 批准号: 10673770
• 负责人: DAVID H GUSTAFSON
• 金额: $ 77.75万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-05 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673770
• 关键词: Accounting; Address; Adopted; Adult; Age; Anxiety; Chronic; Clinical; Communication; Competence; Control Groups; Development; Devices; Diabetes Mellitus; Elderly; Elements; Engineering; Fatigue; Funding; Geriatrics; Goals; Health; Health Care Costs; Health system; Healthcare; Healthcare Systems; Hearing; Hyperlipidemia; Hypertension; Intention; Internet; Intervention; Loneliness; Marketing; Measures; Mediating; Mediator; Medical; Medicare; Mental Depression; Motivation; Obesity; Outcome; Pain; Patients; Personal Satisfaction; Phase; Physical Function; Prediabetes syndrome; Primary Care; Procedures; Quality of life; Randomized; Reading; Research; Research Personnel; Science; Self Determination; Self Management; Services; Sleep disturbances; Symptoms; System; Technology; Testing; Time; Trees; Tremor; United States Agency for Healthcare Research and Quality; Universities; Vision; Visual; Voice; Walking; Wisconsin; Woman; arm; beneficiary; computer science; cost; eHealth; electronic health system; evidence base; expectation; experience; follow-up; health management; improved; intelligent personal assistant; intrinsic motivation; laptop; literacy; men; multiple chronic conditions; older patient; pressure; prevent; primary care clinic; primary outcome; programs; randomized trial; randomized, clinical trials; response; secondary outcome; skills; smart speaker; social; success; theories; therapy design; tool; video chat

PROJECT SUMMARY / ABSTRACT In addition to their debilitating impact on health and well-being, multiple chronic conditions (MCCs) account for 90% of Medicare spending. Among beneficiaries, 65% have 3 or more conditions such as diabetes and hypertension, and 23% have 5 or more. MCCs are often addressed in primary care, where time pressures prevent focusing on self-management—although such skills are crucial for living successfully with MCCs. Our long-term goal is to improve health and self-management for these patients, while reducing healthcare costs. An AHRQ-funded P50 supported our development of Elder Tree (ET). That eHealth system was shown in a randomized trial to improve quality of life and health factors among older adults with MCCs who were high users of primary care. ET provides tools, motivation, and support to help patients manage their health. Despite positive results, many did not use ET extensively, a very common problem with health apps. Our central question is whether adapting and delivering ET with voice-controlled technology can increase ET use, thereby improving quality of life and health outcomes even more than ET on a laptop. Smart speakers, used by talking and listening rather than typing and reading, offer the tantalizing but unproven promise of being easy to use, which may in part explain why the technology is being adopted faster than the internet or TV. Smart displays raise expectations even higher by adding a visual element that enables the system to "show" as well as "tell." We propose an R61/R33 project including a randomized clinical trial involving 282 (after attrition) patients age 65+ with 5 or more chronic conditions, 3 of which must be hypertension, hyperlipidemia, obesity, diabetes, or pre-diabetes. In the proposed 12-month trial plus 6-month follow-up, patients will be randomly assigned to receive ET via a laptop (ET-Text) or a smart display (ET-Voice). The project has the following specific aims: Aim 1: During the R61 phase, continue and complete development of the platform and operational procedures for delivering ET to the smart display group. Aim 2: During the R33 phase, conduct a balanced randomized clinical trial to test these hypotheses: Primary outcome: ET-Voice (vs. ET-Text) patients will have better functional health (a measure including physical function, pain, fatigue, sleep disturbance, anxiety, and depression) over time. Secondary outcomes: ET-Voice (vs. ET-Text) patients will have better outcomes for loneliness, number of symptoms, and healthcare use over time. In addition, amount of ET use, ease of use, and usefulness will be higher for the ET-Voice (vs. ET-Text) group. Mediators: Effects of study arm on outcomes will be mediated by ET use at 6 months and by Self-Determination Theory constructs of competence, social relatedness, and intrinsic motivation. Moderators: ET-Voice (vs. ET-Text) will show greater improvements in the primary outcome for: those age 65-74 vs. 75+ years old, women vs. men, those with 8+ vs. 5-7 chronic conditions, and those with more physical barriers to technology use (e.g. tremors). We will explore whether these moderation effects are also observed for the secondary outcomes.

项目摘要 /摘要 除了对健康和福祉的影响使人衰弱，多个慢性病（MCC）占 90％的医疗保险支出。在受益人中，有65％的人患有3个或更多条件，例如糖尿病和 高血压和23％的人有5个或更多。 MCC经常在初级保健中解决，时间压力很大 防止专注于自我管理 - 尽管这种技能对于成功与MCC生活至关重要。我们的 长期目标是改善这些患者的健康和自我管理，同时降低医疗费用。 AHRQ资助的P50支持了我们对Elder Tree（ET）的发展。这种eHealth系统已在 随机试验以改善高龄的老年人的生活质量和健康因素 初级保健的用户。 ET提供工具，动力和支持，以帮助患者管理健康。尽管 积极的结果，许多人并未广泛使用ET，这是健康应用程序中非常普遍的问题。我们的中心 问题是通过语音控制技术适应和交付ET是否可以增加ET的使用 在笔记本电脑上，改善生活质量和健康成果甚至更大。智能扬声器，通过说话 而不是打字和阅读，而是提供诱人但未经证实的承诺，即易于使用， 这可能部分解释了为什么该技术比互联网或电视更快。智能显示 通过添加一个可让系统“显示”和“告诉”的视觉元素来提高期望。 我们提出了一个R61/R33项目，包括一项随机临床试验，涉及282名患者年龄 65岁以上，有5个或更多的慢性病，​​其中3个必须是高血压，高脂血症，肥胖，糖尿病或 糖尿病前。在拟议的12个月试验以及6个月的随访中，将随机分配给患者 通过笔记本电脑（ET-TEXT）或智能显示（ET-VOICE）接收ET。该项目具有以下特定目标： 目标1：在R61阶段，继续并完成平台和操作程序的完整开发 用于将ET交付给智能显示组。 AIM 2：在R33阶段，进行平衡的随机性 测试这些假设的临床试验：主要结果：ET-VOICE（vs. ET-TEXT）患者将有更好的 功能健康（包括身体功能，疼痛，疲劳，睡眠障碍，动画和 抑郁）随着时间的流逝。次要结局：ET-VOICE（VS. ET-TEXT）患者将有更好的结果 随着时间的流逝，孤独感，符号数量和医疗保健。此外，ET的使用量，易用性， 对于ET-VOICE（VS. ET-TEXT）组，有用性将更高。调解人：研究部门的影响 结果将在6个月的使用情况下通过ET介导 能力，社会相关性和内在动机。主持人：ET-VOICE（VS. ET-TEXT）将显示更大的 改善：65-74岁与75岁以上的那些年龄的主要结果，女性vs.男性，其中8岁以上 与5-7个慢性病，以及具有更多物理障碍的技术使用（例如震颤）。我们将 探索是否也观察到次级结果的这些节奏效应。