An Assessment of Open Access Audio of the Clinical Encounter on Veterans and their Care

对退伍军人临床遭遇及其护理的开放获取音频的评估

基本信息

批准号：
10477935
负责人：
SAUL J. WEINER
金额：
--
依托单位：
JESSE BROWN VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-01 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10477935
关键词：
Accident and Emergency department Address Adherence Adopted Adoption Anxiety Appointment Assessment tool Attention Awareness Behavior Behavior assessment Blinded Blood Pressure Caregivers Caring Chronic Chronic Disease Clinic Clinical Code Communication Comparison arm Complex Confidentiality of Patient Information Data Devices Diabetes Mellitus Disease Effectiveness Emergency department visit Family Focus Groups Foundations Funding General Practitioners Glycosylated Hemoglobin Health Healthcare Healthcare Systems Hospitalization Individual Inpatients Instruction Internet Interview Lead Leadership Legal Life Measures Mediating Medical Medical Care Team Methodology Movement Nature Oncologist Outcome Participant Patients Perception Performance Pharmaceutical Preparations Physicians Primary Care Provider Randomized Randomized, Controlled Trials Readiness Recurrence Reporting Research Research Design Resources Risk Safety Secure Self Management Specialist Specific qualifier value Structure Surveys Technology Telephone Testing Thinking Time Veterans Visit Work Writing arm biomedical data science care outcomes clinical encounter clinically relevant communication behavior connected care connected health contextual factors cost data warehouse design experience follow-up forgetting health care service organization health care service utilization improved innovation interest legal implication medical specialties member new technology next generation patient portal programs provider behavior provider communication secondary analysis stressor technology platform time use tool treatment adherence treatment planning trial design

Accident and Emergency department Address Adherence Adopted Adoption Anxiety Appointment Assessment tool Attention Awareness Behavior Behavior assessment Blinded Blood Pressure Caregivers Caring Chronic Chronic Disease Clinic Clinical Code Communication Comparison arm Complex Confidentiality of Patient Information Data Devices Diabetes Mellitus Disease Effectiveness Emergency department visit Family Focus Groups Foundations Funding General Practitioners Glycosylated Hemoglobin Health Healthcare Healthcare Systems Hospitalization Individual Inpatients Instruction Internet Interview Lead Leadership Legal Life Measures Mediating Medical Medical Care Team Methodology Movement Nature Oncologist Outcome Participant Patients Perception Performance Pharmaceutical Preparations Physicians Primary Care Provider Randomized Randomized, Controlled Trials Readiness Recurrence Reporting Research Research Design Resources Risk Safety Secure Self Management Specialist Specific qualifier value Structure Surveys Technology Telephone Testing Thinking Time Veterans Visit Work Writing arm biomedical data science care outcomes clinical encounter clinically relevant communication behavior connected care connected health contextual factors cost data warehouse design experience follow-up forgetting health care service organization health care service utilization improved innovation interest legal implication medical specialties member new technology next generation patient portal programs provider behavior provider communication secondary analysis stressor technology platform time use tool treatment adherence treatment planning trial design

展开

项目摘要

Background: The medical encounter can be overwhelming in term of the amount of information discussed, its technical nature, and the anxiety it can generate. Easy access to a secure audio recording from any internet enabled device is an available low cost technology that allows patients to “revisit the visit” either alone or sharing with caretakers and family. It has been introduced and tested outside the VA with evidence that it increases patient recall and understanding and may even improve physician performance. Little is known, however, about whether and to what extent these effects lead to better outcomes, such as improved treatment plan adherence and chronic disease self-management. Significance/Impact: This study will assess a new resource for enhancing Veterans capacity to understand their care plan, and share information from their visit with caregivers. The study design is intended to yield information to guide decision makers about the value of bringing “open access audio” (OAA) to VHA. Innovation: The Open Chart movement, in which patients can freely access their written medical information was a major innovation first introduced through the patient portal in 2010, and is rapidly disseminating-- including within VHA. OAA extends the same principles of full transparency and easy access to medical information and, if successful, could also be incorporated into the patient portal. The VHA Office of Connected Care, which manages MyHealtheVet has indicated interest in this project because of its potential to transform the next generation portal. Specific Aims: This study will access, using a randomized controlled trial design, whether the known benefits of OAA (better patient recall and understanding) lead to several desired service utilization and health care outcomes. It will also measure the effect of OAA on provider behaviors that may mediate those outcomes. Throughout, data will be collected on participant and other stakeholder perceptions of the program that, based on prior research on audio- recording in the clinical setting, reflect a readiness to adopt the new technology. Aim 1: Assess the impact of an open access audio program on two behaviors (patient activation, treatment plan adherence), and two chronic condition measures (glycosylated hemoglobin, blood pressure). Secondary analysis will descriptively measure effect size on ED visits and hospital admissions. Aim 2: Assess the impact of open access audio on provider communication and on their attention to patient contextual factors (i.e. individual Veterans needs and circumstances relevant to planning effective care). Aim 3: Assess patient, provider, and leadership perceptions of the extent to which the program is safe, not burdensome, and worthwhile at both the start and at two years into the program. Methodology: The setting will be primary care and diabetes clinics, at two facilities for generalizability. To achieve aims 1 and 2, we propose a randomized controlled three arm design: (1) the encounter is recorded, with provider and patient aware, and uploaded to a server the Veteran, provider, and research team can access post visit; (2) the encounter is recorded, with both parties aware, and uploaded to a server only the research team can access; and (3) the encounter is recorded, with only the patient aware, and uploaded to a server only the research team can access. Resource utilization and disease measures indicated in aims 1 and 2 will be collected in all arms. Comparisons of Arms “1” and “2” enable assessing the impact of the availability of audio on patients (for aim 1). Comparisons of Arm “2” with “3” enables isolating the effect of providers knowing they are being recorded (for aim 2). Data for aim 3 will come from survey tools, focus groups and semi-structured leadership interviews to elicit perceptions of project safety, burden, and value. Next Steps/Implementation: We will work with the Office of Connected Health to identify opportunities, based on the findings for incorporating Open Audio Access into the next generation patient portal.

背景：在讨论的信息的量中，医疗相遇可能是压倒性的技术性质及其可以产生的动画。轻松访问任何互联网的安全音频录制启用设备是一种可用的低成本技术，可让患者单独“重新访问访问”或与看护者和家人共享。它已在VA外引入和测试，有证据表明增加患者的召回和理解，甚至可以提高身体表现。鲜为人知，但是，这些影响是否以及在何种程度上导致更好的结果，例如改善治疗计划的依从性和慢性疾病自我管理。意义/影响：本研究将评估一种新资源，以增强退伍军人的能力他们的护理计划，并与照料者分享他们的访问信息。研究设计旨在产生信息以指导决策者有关将“开放访问音频”（OAA）带到VHA的价值。创新：开放图表运动，患者可以自由获取书面医疗信息是2010年通过患者门户网站引入的主要创新，并且正在迅速传播 - 包括在VHA中。 OAA扩展了完全透明度和轻松访问医疗的相同原则信息，如果成功的话，也可以将其纳入患者门户。 VHA办公室互联护理，管理MyHealthevet对该项目表示兴趣，因为其潜力转换下一代门户。具体目的：本研究将使用随机对照试验设计访问，是否已知的好处 OAA（更好的患者召回和理解）导致了几种所需的服务利用和医疗保健结果。它还将衡量OAA对可能介导这些结果的提供者行为的影响。在整个过程中，数据将根据参与者和其他利益相关者对该计划的看法收集，该计划的先前研究在临床环境中记录，反映了采用新技术的准备。目标1：评估开放访问音频计划对两种行为的影响（患者激活，治疗）计划依从性）和两种慢性病度量（糖基化血红蛋白，血压）。次要分析将描述地测量急诊就诊和住院的影响大小。目标2：评估开放访问音频对提供商沟通的影响以及对患者的关注上下文因素（即，个人退伍军人的需求和环境与计划有效护理有关）。目标3：评估患者，提供者和领导层对计划安全的程度，而不是燃烧的，在计划的开始和两年内都值得。方法论：设置将是初级保健和糖尿病诊所，在两个设施中，可概括。到达到目标1和2，我们提出了一个随机控制的三个ARM设计：（1）记录相遇，提供者和患者知道，并将其上传到服务器，老兵，提供商和研究团队可以访问后访问；（2）记录了相遇，双方都知道，仅上传到服务器研究团队可以访问；（3）只有患者才知道遭遇，并上传到服务器只有研究团队才能访问。目标1中指示的资源利用和疾病措施1 2将收集在所有武器中。武器“ 1”和“ 2”的比较使评估的影响患者的音频可用性（AIM 1）。 ARM“ 2”与“ 3”的比较可以隔离提供者知道他们正在被记录下来（AIM 2）。 AIM 3的数据将来自调查工具，重点小组和半结构化领导访谈，以引起对项目安全，负担和价值的看法。下一步/实施：我们将与Connected Health办公室合作，以确定机会，根据将开放音频访问纳入下一代患者门户的发现。