Leveraging Heath Information Technology to Improve Post-Discharge Management for Patients with Heart Failure

利用健康信息技术改善心力衰竭患者的出院后管理

• 批准号: 10592045
• 负责人: Eun Ji Kim
• 金额: $ 19.17万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592045
• 关键词: Address; Applications Grants; Behavior Therapy; Behavioral Sciences; Cardiovascular system; Caring; Cellular Phone; Clinical; Clinical Investigator; Computers; Effectiveness; Failure; Feedback; Focus Groups; Foundations; Goals; Health; Health system; Heart failure; Homelessness; Hospitalization; Hospitals; Individual; Intervention; K-Series Research Career Programs; Knowledge; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Monitor; Nurses; Outcome; Patient Care; Patient Triage; Patients; Perception; Physicians; Positioning Attribute; Randomized; Randomized, Controlled Trials; Research; Research Activity; Research Personnel; Research Project Grants; Research Project Summaries; Resources; Risk; Sample Size; Services; Technology; Testing; Text; Text Messaging; Time; Training; Training Activity; Transcript; Use Effectiveness; Work; automated text message; career; experience; group intervention; health care service utilization; health information technology; health literacy; hospital readmission; implementation science; improved; insight; low health literacy; patient handout; patient navigator; poor health outcome; posthospitalization care; power analysis; prototype; screening program; skills; social; social health determinants; text messaging intervention; theories; tool; trial design; uptake; usability; usual care arm

Project Summary My long-term career goal is to become a clinician investigator, who uses health information technology (IT) to improve cardiovascular outcomes among patients with social needs. The research goal of this application is to use health IT to reduce preventable readmissions for heart failure (HF) among patients with low health literacy with the incorporation of behavioral science and usability testing. Social determinants of health (SDH) account for 80% of health outcomes, and social needs are associated with poor health outcomes, including 30-day readmissions. Addressing individuals’ social needs has been associated with improved clinical outcomes, but may take a prolonged time to effectively reduce 30-day readmissions. Health literacy, which measures a patient’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, is associated with patients’ health outcomes. Low health literacy is common among patients with HF, and leads to poor management of HF. Extant interventions, such as patient navigators and handouts, have been utilized successfully to improve medical care for patients with low health literacy, but they are episodic and resource-intensive. The use of health IT tools, such as a personalized, automated text-message-based application, can be utilized for post-hospitalization care. Our preliminary study indicates that patients with HF who use this application had reduced 30-day readmissions, compared to patients with HF who did not use the application. However, the number of patients with HF using the application has been limited, due to low uptake and high attrition rate. The overall objective of the proposed research project is to incorporate nudges, and address barriers to improve patients’ use of the application, and conduct a pilot randomized controlled trial (RCT) to evaluate the application’s use in reducing 30-day readmissions. We will conduct qualitative work to gain insights into how to adapt an extant text messaging intervention to improve its use among patients with low health literacy (Aim 1), conduct usability testing and iterative revision of the application (Aim 2), and conduct a pilot RCT to evaluate the acceptability, feasibility, and preliminary efficacy of using behavioral interventions to increase the application use for patients with HF post-discharge (Aim 3). The training from this mentored career development award will provide skills in four domains: 1) behavioral science; 2) implementation science; 3) health literacy; and 4) RCT design and conduct. The proposed research activities, and the training and mentoring plans will provide the foundation for my career as an independent clinician investigator.

项目摘要 我的长期职业目标是成为一名临床研究者，他使用健康信息技术（IT） 改善有社会需求的患者的心血管结局。该应用的研究目标是 使用健康IT减少健康素养患者的心力衰竭（HF）的可预防再入院 随着行为科学和可用性测试的结合。卫生社会决定者（SDH）帐户 对于80％的健康成果，社会需求与不良健康结果有关，包括30天 再入院。满足个人的社会需求与改善临床结果有关，但是 可能需要长时间的时间才能有效减少30天的再入院。健康素养，衡量 患者找到，理解和使用信息和服务的能力，以告知与健康相关的决策和 对自己和他人的行动与患者的健康成果有关。低健康素养很常见 在HF患者中，导致HF治疗不佳。现存的干预措施，例如患者 导航员和讲义已成功地用于改善健康状况不佳的患者的医疗服务 扫盲，但它们是情节和资源密集的。使用健康IT工具，例如个性化工具 自动化的基于文本消息的应用程序可用于院后护理。我们的初步研究 表明使用此应用此应用的HF患者减少了30天的再入院 没有使用该应用的HF患者。但是，使用HF的患者数量使用 由于吸收低和较高的属性率，应用程序受到限制。提议的总体目标 研究项目将纳入午睡，并解决改善患者使用该应用程序的障碍，并 进行飞行员随机对照试验（RCT），以评估该应用程序在减少30天中的用途 再入院。我们将进行定性工作，以了解如何适应现存的文字消息传递 干预措施以改善健康素养低的患者（AIM 1），进行可用性测试和 迭代修订应用程序（AIM 2），并进行试点RCT以评估可接受性，可行性， 以及使用行为干预措施增加HF患者的应用使用的初步效率 放电后（目标3）。该修订职业发展奖的培训将在四个中提供技能 域：1）行为科学； 2）实施科学； 3）健康素养； 4）RCT设计和行为。 拟议的研究活动以及培训和心理计划将为我的 作为独立临床研究者的职业。