A multi-level intervention to increase access and use of patient portals for diabetes management in community health centers (MAP)

多层次干预措施，以增加社区卫生中心 (MAP) 糖尿病管理患者门户的访问和使用

基本信息

批准号：
10649414
负责人：
JULIE A WAGNER
金额：
$ 20.86万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-17 至 2024-09-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10649414
关键词：
Address Adoption Adult Appointment Behavior Behavioral Biological Factors Black race Blood Glucose Caring Clinic Communication Communities Community Health Aides Comprehensive Health Care Data Decision Making Diabetes Mellitus Disparity Education Educational Materials Elderly Emergency department visit Ethnic Origin Focus Groups Fostering General Population Health Health Personnel Health Resources Healthcare Healthcare Systems Healthy Eating Hospitalization Internet Intervention Interview Knowledge Latinx Measures Medical Care Team Medical Records Methods Modeling Morbidity - disease rate Neighborhood Health Center Non-Insulin-Dependent Diabetes Mellitus Nurses Office Visits Outcome Participant Patient-Centered Care Patients Pharmaceutical Preparations Physical activity Play Population Prevalence Preventive screening Protocols documentation Provider Psychosocial Factor Public Health Qualitative Methods Research Personnel Resources Role Secure Self Efficacy Services Socioeconomic Status Tablets Testing Training Vulnerable Populations World Health Organization clinical care cost design diabetes distress diabetes management diabetes self-management disparity reduction eHealth ethnic minority population experience glucose monitor glycemic control health care availability health care disparity health disparity health equity health inequalities improved intervention delivery literacy low health literacy low socioeconomic status mathematical ability mortality novel outreach participant interview patient engagement patient portal primary outcome provider communication psychosocial racial diversity racial minority population secondary outcome social health determinants socioeconomics systematic review technology training therapy design underserved community web site

项目摘要

Abstract In the US, there are significant health care disparities in the prevalence, morbidity, and mortality of type 2 diabetes (T2D) in racial and ethnic minority populations. Increased patient portal use, such as accessing medical records and secure messaging with providers has the potential to improve engagement with care and diabetes health outcomes. Yet, there are substantial disparities in portal use by adults who are of diverse race/ethnicity and with limited socioeconomic resources. Over 1,400 community health centers (CHCs) in the US provide comprehensive health care to adults of diverse races and ethnicities in underserved communities and play a critical role in addressing health inequities in T2D care. We propose to develop a multi-level intervention to increase access and use of patient portals for diabetes management (MAP) in community health centers (CHC) aligned with the World Health Organization (WHO) Social Determinants of Health Equity framework. The intervention will: 1) provide free access to tablets and internet (material circumstances); 2) technology training and ongoing support (psychosocial factors); 3) assess social determinants of health and refer to community resources (material circumstances); and, 4) support diabetes self-management behaviors and refer to clinic services (behavioral and biological factors). MAP will be delivered by community health workers (CHW) and nurses already embedded in CHCs (healthcare system). The study aims are to: 1) Optimize components of the MAP intervention for adults with T2D who access healthcare at CHCs by conducting focus groups/interviews with adults with T2D and health care providers (n=24) from two CHCs using established qualitative methods; and 2) determine the effect size of MAP use for adults with T2D at two CHCs (n=36) on the primary outcomes of portal use and A1C and secondary outcomes of: a) patient engagement with care, T2D self-management, and psychosocial outcomes. Using a within subjects, pre-post design we will pilot MAP in adults with T2D who are portal naive. We will use generalized linear mixed model (GLMM), incorporating correlations among repeated measures (baseline, 3 months, and 6 months) to analyze data. We will evaluate portal use factors associated with improvement in outcomes. We will rigorously evaluate the feasibility of MAP (acceptability, demand, implementation, adaptation, and integration) using an established framework and mixed methods. Lastly, we will explore the use of publicly available diabetes and health resources on the internet by adults with T2D when provided access to a tablet and internet. Results of this study will have important implications on the potential of a novel multi-level intervention provided in CHCs to improve patient portal use, diabetes self-management, and glycemic control in adults of diverse race/ethnicity with limited socioeconomic resources.

抽象的在美国，2 型糖尿病的患病率、发病率和死亡率方面存在显着的医疗保健差异少数种族和族裔人群中的糖尿病（T2D）。增加患者门户的使用，例如访问医疗记录和与提供者的安全消息传递有可能提高护理和糖尿病的参与度健康结果。然而，不同种族/族裔的成年人在门户网站的使用方面存在巨大差异并且社会经济资源有限。美国有超过 1,400 个社区卫生中心 (CHC) 提供为服务不足的社区中不同种族和族裔的成年人提供全面的医疗保健，并发挥在解决 T2D 护理中的健康不平等问题方面发挥着关键作用。我们建议制定多层次的干预措施增加社区卫生中心 (CHC) 糖尿病管理 (MAP) 患者门户的访问和使用与世界卫生组织 (WHO) 健康公平社会决定因素框架保持一致。这干预措施将： 1) 提供免费使用平板电脑和互联网的机会（物质条件）； 2）技术培训和持续的支持（心理社会因素）； 3) 评估健康的社会决定因素并参考社区资源（物质条件）； 4) 支持糖尿病自我管理行为并转诊至诊所服务（行为和生物因素）。 MAP 将由社区卫生工作者 (CHW) 提供护士已经融入CHC（医疗保健系统）。研究目的是： 1）优化通过开展焦点小组/访谈，对在 CHC 获得医疗保健的 T2D 成人进行 MAP 干预使用既定的定性方法，对患有 T2D 的成人和来自两个 CHC 的医疗保健提供者 (n=24) 进行调查； 2) 确定在两个 CHC (n=36) 的成人 T2D 中使用 MAP 对主要结局的影响大小门户网站使用和 A1C 的影响以及次要结果：a) 患者参与护理、T2D 自我管理，以及心理社会结果。使用受试者内、事前设计，我们将在患有 T2D 的成人中试点 MAP，他们门户天真。我们将使用广义线性混合模型 (GLMM)，结合重复项之间的相关性分析数据的措施（基线、3 个月和 6 个月）。我们将评估相关的门户使用因素随着结果的改善。我们将严格评估MAP的可行性（可接受性、需求、使用既定框架和混合方法进行实施、适应和整合）。最后，我们将探索患有 T2D 的成人在以下情况下如何使用互联网上公开的糖尿病和健康资源：提供平板电脑和互联网的访问。这项研究的结果将对以下领域的潜力产生重要影响：在 CHC 中提供一种新颖的多层次干预措施，以改善患者门户网站的使用、糖尿病自我管理和社会经济资源有限的不同种族/族裔成年人的血糖控制。