Expanding Patient Engagement in Diabetes Care: Patient Portal Innovation

扩大患者对糖尿病护理的参与：患者门户创新

• 批准号: 10006820
• 负责人: William Martinez
• 金额: $ 71.65万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10006820
• 关键词: Address; Adopted; American; Attitude; Awareness; Blindness; Cardiovascular Diseases; Caring; Chronic; Clinical; Clinical Services; Data; Development; Diabetes Mellitus; Disease; Education; Electronic Health Record; Eye diseases; Feedback; Health Services; Health Services Accessibility; Health Status; Infrastructure; Intervention; Interview; Kidney Diseases; Medical Care Team; Methodology; Monitor; Notification; Ophthalmic examination and evaluation; Outcome; Patient Care; Patients; Physicians; Preventive Health Services; Preventive service; Primary Care Physician; Randomized Controlled Trials; Research; Schedule; Self Management; Services; Surveys; System; Technology; Testing; Time; Translational Research; Vaccines; Visit; Workload; colon cancer screening; cost; dashboard; design; diabetic; evidence base; evidence based guidelines; experience; health data; health information technology; health literacy; improved; innovation; literacy; novel; patient engagement; patient portal; prevent; public health relevance; service intervention; usability; user centered design

Project Summary/Abstract Evidence-based diabetes monitoring & preventative services can prevent or delay many costly and highly morbid disease-related complications, yet many patients do not receive all clinically-meaningful, evidence- based services. For example, while detecting and treating early diabetic eye disease can reduce the development of severe vision loss by an estimated 60%, approximately 40% of Americans with diabetes do not receive an annual eye exam. Prior research has demonstrated numerous barriers to the completion of evidence-based diabetes monitoring & preventative services including patient factors (eg, lack of awareness and limited health literacy) and clinician/system factors (eg, limited physician time and patient support between visits). Attempts to increase diabetes monitoring & preventative services have had only modest results. To achieve optimal rates of these services, an intervention is urgently needed that improves clinical efficiency by decreasing clinician workload, is appropriate for patients with varying levels of health literacy, and is highly scalable and sustainable. By providing an engaging and convenient means to track and visualize health data, obtain education and guidance, receive notifications, and connect patients and doctors, patient portals offer a promising platform to enhance access to health services while overcoming the limitations of costly and difficult to scale face-to-face interventions. Our research team previously applied user-centered Design Sprint methodology to develop patient portal features and functionality that were engaging and satisfying for a diverse group of patients with diabetes to use and provided users with a better understanding of their diabetes health data (eg, A1C). Feedback from users indicated a desire to self-order and self-schedule services when they become due. Using a similar approach and with strong institutional endorsement, we will design, usability test, and evaluate a novel patient portal intervention to: (a) notify patients when selected, clinically-meaningful, evidence-based diabetes monitoring & preventative services (eg, annual eye exam) become due and provide reminders for timely completion, (b) promote understanding of the importance of these services through literacy sensitive content, and (c) allow patients, when due by evidence-based guidelines, to ‘self-order’ (requires primary care physician (PCP) single-click co-signature) lab tests (eg, A1C) and vaccines prior to doctor’s visits and self-schedule clinical services (eg, eye exam). Specifically, we aim to: (1) apply Design Sprint methodology and usability testing to design and test a patient portal intervention (described above) that can overcome patient and clinician/system barriers to completing evidence-based, clinically meaningful, diabetes monitoring & preventative services among a diverse group of patients, (2) evaluate the effect of the patient portal intervention developed in Aim 1 on the completion of those services in a pragmatic, cluster randomized controlled trial, and (3) assess PCP’s attitudes and experiences, through surveys and interviews, regarding the acceptability and usefulness of the intervention and its impact on clinical efficiency.

项目摘要/摘要 基于证据的糖尿病监测和预防服务可以预防或延迟许多昂贵且高度的 病态与疾病相关的并发症，但许多患者没有接受所有临床上的，证据 - 基于服务。例如，在检测和治疗早期糖尿病眼病可以减少 估计有60％的严重视力丧失发展，大约40％的糖尿病的美国人没有 接受年度眼科检查。先前的研究证明了完成的许多障碍 基于证据的糖尿病监测和预防服务，包括患者因素（例如，缺乏意识 和有限的健康素养）和临床/系统因素（例如，身体时间有限和患者支持 访问）。尝试增加糖尿病监测和预防服务的尝试只有适度的结果。到 达到这些服务的最佳速度，迫切需要进行干预，以提高临床效率 减少临床工作量，适合具有不同健康素养水平的患者，并且高度高 可扩展和可持续性。通过提供引人入胜且方便的手段来跟踪和可视化健康数据， 获得教育和指导，接收通知并联系患者和医生，患者门户提供 有希望的平台可以增强获得卫生服务的机会，同时克服昂贵和困难的局限 进行面对面的干预措施。我们的研究团队以前以用户为中心的设计冲刺 开发患者门户网站功能和功能的方法，这些功能吸引了潜水员 一群糖尿病患者使用，并为用户提供了对糖尿病健康的更好了解 数据（例如A1C）。用户的反馈表示，当他们的自行序和自我安排服务的愿望 到期。使用类似的方法并获得强烈的机构认可，我们将设计，可用性测试， 并评估一种新型的患者门户干预措施：（a）选择时通知患者，在临床上含糊不清， 基于证据的糖尿病监测和预防措施（例如，年度眼科检查）应付并提供 提醒及时完成的​​提醒，（b）通过 扫盲敏感的内容，（c）允许患者通过基于证据的准则，以“自我顺序” （需要初级保健物理学（PCP）单击共同签名）实验室测试（例如A1C）和疫苗 医生的访问和自我安排临床服务（例如眼科检查）。具体来说，我们的目的是：（1）应用设计 Sprint方法论和可用性测试以设计和测试患者门户的干预（上述） 可以克服患者和临床/系统障碍，以完成基于证据的临床意义， 糖尿病监测和预防服务的患者组中，（2）评估 AIM 1在AIM 1中开发的患者门户干预措施在务实的，集群中完成这些服务 随机对照试验以及（3）通过调查和访谈评估PCP的出勤率和经验， 关注干预措施的可接受性和实用性及其对临床效率的影响。