Medtable: An EMR Strategy to Promote Patient Medication Understanding and Use

Medtable：促进患者药物理解和使用的 EMR 策略

• 批准号: 8217291
• 负责人: Daniel G Morrow
• 金额: $ 58.9万
• 依托单位: UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-07 至 2014-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8217291
• 关键词: Address; Adherence; Adult; Blood Glucose; Chicago; Chronically Ill; Clinic; Clinic Visits; Cognition; Cognitive; Collaborations; Communication; Complex; Comprehension; Computerized Medical Record; Counseling; Development; Elderly; Ensure; Environment; Food; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health; Health behavior outcomes; Information Technology; Instruction; Internal Medicine; Intervention; Interview; Knowledge; Language; Medical; Medication Errors; Metabolic Diseases; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Office Visits; Outcome; Paper; Patient Care; Patient Education; Patient Monitoring; Patient-Centered Care; Patients; Pharmaceutical Preparations; Physicians; Process; Protocols documentation; Provider; Regimen; Reporting; Schedule; Self Care; Simulate; System; Testing; Time; Training; Update; Visual; Wolves; Work; Writing; base; glycemic control; health information technology; health literacy; improved; literacy; meetings; patient oriented; patient population; prospective memory; prototype; provider intervention; public health relevance; randomized trial; skills; tool; treatment as usual

DESCRIPTION (provided by applicant): The broad goal of this project is to improve knowledge of and adherence to medication regimens and health outcomes among adults with type 2 diabetes or other metabolic disorders. These patients have complex self-care needs, but limited literacy and cognitive skills to meet these needs. Medication error in ambulatory settings is widespread and costly, and often associated with inadequate patient knowledge about medication, especially among chronically ill adults with limited health literacy. Inadequate knowledge is often traced to limited communication with providers, in part because of barriers such as limited patient contact time and communication training, and lack of system-level support for consistent use of patient-centered strategies. There is a need to leverage information technology (IT) to provide system-based support for patient-centered communication. We will evaluate an Electronic Medical Record (EMR)-based tool (the Medtable) to support provider/patient communication and improve medication knowledge, adherence, and health outcomes among chronically ill adults with complex medication regimens. A paper-based Medtable has been found to help older adults create accurate medication schedules in a simulated patient/provider communication task (Morrow et al., 2008). Benefits for patients should be enhanced if the Medtable is integrated with an EMR, giving providers ready access to relevant background information and current medication lists that patients can update, so providers can generate and tailor the Medtable for a diverse set of patients. This system provides an integrated approach to patient education about medications, from prescribing to counseling during office visits. As a result, patients would not only understand how to take their medications, but develop concrete plans for doing so. Specific aims of the project are: 1) Refine the Medtable prototype for use in an EMR environment. This includes developing protocols for generating patient- specific Medtables and educating providers to use them in medical encounters. 2) Evaluate the Medtable's impact on patient care processes and outcomes. We test the following hypotheses about communication processes: H1) Nurses who work with patients supported by the Medtable will more likely use patient-centered communication strategies (e.g., provide complete information, check patient comprehension); H2) Patients in the intervention condition will be more satisfied with communication about medication. We also test the following hypotheses about patient outcomes. Compared to usual care patients, patients receiving the Medtable intervention will: H3) know more about their medications; H4) adhere more accurately to their medication regimens; H5) more likely have blood glucose (glycosylated hemoglobin, HbA1c) levels in the target range. Aim 1 will be accomplished by interviewing physicians and their patients as the system is refined to ensure ease of using the system, and by collecting preliminary evidence that the Medtable improves patient/provider communication. After establishing initial feasibility and ensuring provider acceptance of the system, Aim 2 is addressed by a randomized trial at the general internal medicine clinics in Chicago and Peoria (IL), comparing patients who use the Medtable with their providers to those receiving usual care. PUBLIC HEALTH RELEVANCE: Findings from this project will help integrate health literacy models with models of patient/provider communication and language comprehension in order to guide development of an IT-based tool (the Medtable) that supports the patient/provider communication needed to improve patient knowledge, adherence, and health outcomes. We focus on older adults with type 2 diabetes, complex medication regimens, and limited health literacy skills, because they are most in need of system-based support. The Medtable supports consistent use of patient- centered communication and counseling strategies at the point of prescribing medications, with the potential to integrate these practices with medication dispensing to create an integrated patient-centered medication use system. Such a system should mitigate the impact of inadequate health literacy on patients' health behaviors and outcomes.

描述（由申请人提供）：该项目的广泛目标是提高对2型糖尿病或其他代谢疾病的成年人中对药物治疗方案和健康成果的认识。这些患者有复杂的自我保健需求，但是有限的识字能力和认知技能可以满足这些需求。卧床环境中的药物错误是普遍且昂贵的，并且通常与患者有关药物的知识不足，尤其是在健康素养有限的长期患病成年人中。知识不足通常可以追溯到与提供者的沟通有限，部分原因是诸如患者的接触时间和沟通培训有限，以及缺乏系统级别的支持，无法持续使用以患者为中心的策略。有必要利用信息技术（IT）为以患者为中心的沟通提供基于系统的支持。我们将评估基于电子病历（EMR）的工具（MEDTable），以支持提供者/患者的沟通，并改善具有复杂药物治疗方案的长期患病成年人的药物知识，依从性和健康状况。已经发现基于纸的Medtable可以帮助老年人在模拟的患者/提供者的通信任务中创建准确的药物计划（Morrow等，2008）。如果Medtable与EMR集成，则应增强患者的好处，使提供者可以访问相关的背景信息和当前患者可以更新的药物清单，以便提供者可以为多样化的患者生成和量身定制。该系统为患者教育提供了一种综合方法，从开处方到办公室访问期间的咨询。结果，患者不仅会了解如何服用药物，而且还制定了这样做的具体计划。该项目的具体目的是：1）完善用于在EMR环境中使用的梅特式原型。这包括开发用于生成特定于患者的MEDTABLE的协议，并教育提供者将其用于医疗相遇。 2）评估Medtable对患者护理过程和结果的影响。我们测试了有关沟通过程的以下假设：H1）与由Medtable支持的患者一起工作的护士更有可能使用以患者为中心的沟通策略（例如，提供完整的信息，检查患者的理解力）； H2）处于干预条件的患者将对有关药物的沟通更加满意。我们还测试了有关患者预后的以下假设。与通常的护理患者相比，接受Medtable干预的患者将：H3）更多地了解其药物； H4）更准确地遵循其药物治疗方案； H5）可能在靶范围内具有血糖（糖基化血红蛋白，HBA1C）水平。 AIM 1将通过采访医生及其患者来完成，因为该系统的完善是为了确保使用该系统，并收集了Medtable改善患者/提供者的沟通的初步证据。在确定了最初的可行性并确保提供者接受该系统后，AIM 2通过芝加哥和Peoria（IL）的通用内科诊所的随机试验解决，将使用MEDTABLE与其提供者使用的患者与接受常规护理的患者进行了比较。 公共卫生相关性：该项目的发现将有助于将健康素养模型与患者/提供者的沟通和语言理解模型相结合，以指导基于IT的工具（MEDTABL）的开发，以支持改善患者/提供者的沟通，以改善患者知识，依从性和健康状况。我们专注于2型糖尿病，复杂的药物治疗方案和有限的健康素养技能的老年人，因为他们最需要基于系统的支持。 Medtable支持在处方药物时持续使用以患者为中心的沟通和咨询策略，并有可能将这些实践与药物分配相结合以创建以患者为中心的药物使用系统。这样的系统应减轻健康素养对患者健康行为和结果的影响。

项目成果

An EMR-based tool to support collaborative planning for medication use among adults with diabetes: design of a multi-site randomized control trial.

一种基于 EMR 的工具，支持成人糖尿病患者药物使用的协作规划：多中心随机对照试验的设计。

• DOI: 10.1016/j.cct.2012.05.010
• 发表时间: 2012
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Morrow,DanielG;Conner-Garcia,Thembi;Graumlich,JamesF;Wolf,MichaelS;McKeever,Stacey;Madison,Anna;Davis,Kathryn;Wilson,ElizabethAH;Liao,Vera;Chin,Chieh-Li;Kaiser,Darren
• 通讯作者: Kaiser,Darren