Using Smart Devices to Implement an Evidence-based eHealth System for Older Adults

使用智能设备为老年人实施循证电子医疗系统

• 批准号: 10024258
• 负责人: DAVID H GUSTAFSON
• 金额: $ 39.03万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10024258
• 关键词: Using; Smart; Devices; Implement; Evidence

PROJECT SUMMARY AHRQ previously funded the development of Elder Tree (ET), a laptop-based eHealth system shown in a randomized trial to improve quality of life and health factors among older adults with multiple chronic conditions (MCCs) such as diabetes and hypertension. MCCs are pervasive and costly among older adults, reducing quality of life and accounting for 90% of Medicare spending. Self-management can help patients control their conditions, but these skills are rarely taught in primary care. ET provides tools and support for such self- management and addresses the frustration, discouragement, and loneliness shared by all patients with MCCs, regardless of specific disease. Despite positive results, though, many study participants did not use ET extensively, a problem for all health apps. In a separate survey, we learned that more than 60% of non-users abandoned ET because the computer was too hard to use. Voice-controlled "smart" technology may solve this problem. Smart speakers, used by speaking and listening rather than typing and reading, avoid barriers to use such as poor vision, tremors, and interface complexity; they have been adopted at a rate faster than the Internet or TV, especially among older adults. Smart displays enhance the system with a visual element, helping users remember content and creating access to media meant to be viewed. This application proposes to test the ability of voice-activated technology to expand the implementation and sustain the use of a proven electronic health system. Specifically, we propose to test whether older adults with MCCs will use and benefit more from ET delivered by a smart system (speaker plus display), due to ease of use, than from a laptop version of ET. The proposal has 2 aims: 1) develop the smart system platform (ET-SS) and 2) test it against laptop ET (ET-LT) in a 2-arm RCT. The trial will randomize 220 patients age 65+ with 4 or more chronic conditions to receive for 8 months either ET-LT or ET-SS. We hypothesize that: · patients with ET-SS (vs. ET-LT) will have greater ET use and better quality of life in month 8. · these clinical outcomes will improve: a) 30-day hospital readmissions), b) medication adherence, and c) composite score of HbA1c, mg/dL, mmHg, FEV-1, BMI, PHQ-8, FAS-GFR, and Brief Pain Inventory. · the amount of ET use at 4 months will mediate the effects of ET at 8 months (i.e. greater use at 4 months=greater effects at 8 months), and negative affect and Self-Determination Theory constructs of competence, social relatedness, and intrinsic motivation will mediate the effects of ET use. · ET-SS will have better outcomes for women and for patients with 6+ (vs. 4-5) chronic conditions. We, the investigators who developed ET, have conducted numerous RCTs of eHealth systems and published extensively. To our knowledge, this will be the first large RCT of a smart system as a platform to implement and disseminate a health intervention. The result could make ET more accessible and effective for older patients, improve their quality of life, and point the way to more impactful delivery of future eHealth innovations.

项目摘要 AHRQ先前资助了Elder Tree（ET）的发展，ET Tree（ET）是一种基于笔记本电脑的eHealth系统 随机试验以改善具有多种慢性病的老年人的生活质量和健康因素 （MCC），例如糖尿病和高血压。在老年人中，MCC无处不在且昂贵，减少 生活质量和占医疗保险支出90％的核算。自我管理可以帮助患者控制他们 条件，但是这些技能很少在初级保健中教授。 ET为这种自我提供工具和支持 管理和解决所有MCC患者共享的挫败感，沮丧和孤独感， 不论特定疾病。尽管有积极的结果，但许多研究参与者没有使用ET 广泛地是所有健康应用程序的问题。在另一项调查中，我们了解到超过60％的非用户 放弃了ET，因为计算机太难使用了。语音控制的“智能”技术可以解决这个问题 问题。智能扬声器，通过说话和聆听而不是打字和阅读，避免使用障碍 例如视力，震颤和界面复杂性；它们的采用速度比 互联网或电视，尤其是在老年人中。智能显示通过视觉元素增强系统， 帮助用户记住内容并创建对要查看的媒体的访问。 该申请提案，以测试语音激活技术扩展实施的能力和 维持验证的电子卫生系统的使用。具体来说，我们建议测试老年人是否 MCC将通过智能系统（Speaker Plus Display）提供的ET使用和受益更多，因为 使用，而不是来自ET的笔记本电脑版本。该提案有2个目标：1）开发智能系统平台（ET-SS） 2）在2臂RCT中对其对笔记本电脑ET（ET-LT）进行测试。该试验将将220名65岁以上的患者随机，4或 更多的慢性条件可以接收8个月的ET-LT或ET-SS。我们假设这一点： ·ET-SS（VS. ET-LT）患者将在第8个月具有更大的ET使用和更好的生活质量。 ·这些临床结果将有所改善：a）30天的医院再入院），b）药物依从性和c） HBA1C，MG/DL，MMHG，FEV-1，BMI，PHQ-8，FAS-GFR和简短疼痛清单的综合评分。 ·4个月时的ET使用量将介导8个月时ET的影响（即4个月的使用量更大 月份= 8个月的更大影响），以及负面影响和自决理论的构建 能力，社会相关性和内在动机将介导ET使用的影响。 ·ET-SS对于女性和6+（vs. 4-5）慢性疾病的患者的结果将更好。 我们开发ET的调查人员已经进行了许多eHealth系统的RCT并发布了 广泛。据我们所知，这将是智能系统的第一个大型RCT作为实施的平台 并传播健康干预措施。结果可以使ET更容易访问和有效 患者，提高生活质量，并为更具影响力的未来eHealth创新提供了道路。