Effects of a Novel, Scalable, and Sustainable Patient Portal Intervention on Diabetes-Related Outcomes: A Pragmatic Randomized Controlled Trial

新颖、可扩展且可持续的患者门户干预对糖尿病相关结果的影响：一项务实的随机对照试验

• 批准号: 10344030
• 负责人: William Martinez
• 金额: $ 76.68万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-20 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10344030
• 关键词: Academic Medical Centers; Address; Adherence; Adoption; Adult; Affect; Attention; Behavior; Behavioral; Blood Pressure; Body mass index; Caring; Cholesterol; Clinic; Clinical; Communities; Data; Data Display; Diabetes Mellitus; Disease; Education; Electronic Health Record; Ensure; Fast Healthcare Interoperability Resources; Feedback; Future; Glucose; Glycosylated hemoglobin A; Health; Health Services Accessibility; Health Technology; Health system; Healthcare Systems; Hospitals; Influenza vaccination; Intervention; Knowledge; Language; Low-Density Lipoproteins; Maintenance; Measures; Mediating; Mediation; Mediator of activation protein; Medical; Medical Care Team; Medical center; Methodology; Mobile Health Application; Modeling; Monitor; Motivation; Nature; Non-Insulin-Dependent Diabetes Mellitus; Notification; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Premature Mortality; Primary Health Care; Randomized; Randomized Controlled Trials; Readiness; Research; Self Care; Self Management; Site; Specific qualifier value; System; Technology; Testing; Woman; Work; base; behavioral outcome; cost; design; diabetes self-management; diet and exercise; dietary adherence; ethnic diversity; ethnic minority population; experience; follow-up; glycemic control; health data; health inequalities; health information technology; health literacy; improved; improved outcome; interoperability; intervention effect; literacy; novel; patient engagement; patient population; patient portal; prevent; primary outcome; psychosocial; public health relevance; racial and ethnic; racial diversity; recruit; routine care; skills; study population; therapy design; treatment as usual; uptake; usability; user centered design

Project Summary/Abstract There is an urgent need for effective diabetes self-management interventions that are convenient, scalable, sustainable, and able to meet the needs of diverse patients and those with limited health literacy that may be disproportionately affected by the disease. Based on our preliminary studies, My Diabetes Care (MDC) may fill this critical gap by bringing together some of the best aspects of diabetes mHealth apps and incorporating them into a patient portal intervention that was developed to be interoperable with a variety of electronic health records (EHRs) and that offers direct integration into routine care without creating additional work for healthcare teams or the need for additional staff. MDC is a multi-faceted patient portal intervention designed to help patients better understand their diabetes health data as well as promote and support self-management. Developed at Vanderbilt University Medical Center (VUMC), MDC uses infographics to facilitate users' understanding of their diabetes health data, incorporates motivational strategies and access to an online patient support community, and provides literacy level-appropriate and tailored diabetes self-care information. To ensure interoperability and optimize scalability, we built MDC using Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resource (SMART on FHIR) that allows MDC to be installed into a wide variety of EHR platforms across the U.S. Our preliminary studies suggest MDC is acceptable, feasible, improves understanding of diabetes health measures, and increases patient activation. The objective of the proposed research is to: (1) expand MDC's display of user's diabetes health data beyond hemoglobin A1C, blood pressure, cholesterol, and flu vaccination status to include microalbumin and BMI and enhance access by creating a Spanish-language version; (2) evaluate the effects of the expanded & enhanced version of MDC on diabetes-related outcomes while demonstrating its scalability by integrating it into another health system and conducting a pragmatic randomized controlled trial in an ethnically and racially diverse patient population, and (3) examine how the effects of MDC arise by studying causal mediators. The proposed work is important because racial/ethnic minorities and those with limited health literacy are more likely to experience barriers to diabetes self-care and technology use. By designing, testing, and evaluating, MDC in diverse groups of patients including those with limited health literacy and developing a Spanish language version, we will advance the understanding of how to create patient-facing health technologies to achieve broad uptake and address health inequities. By leveraging SMART on FHIR, our project will also demonstrate the current state of the art by implementing and testing MDC without needing to rebuild it and will serve as a model for future patient portal-based interventions.

项目概要/摘要 迫切需要有效的糖尿病自我管理干预措施，这些干预措施必须方便、可扩展、 可持续的，能够满足不同患者和健康素养有限的患者的需求 受该疾病的影响尤为严重。根据我们的初步研究，我的糖尿病护理 (MDC) 可能会填补 通过汇集糖尿病移动医疗应用程序的一些最佳方面并整合来弥补这一关键差距 将它们纳入患者门户干预措施中，该干预措施可与各种电子医疗互操作 记录（EHR），并且可以直接集成到日常护理中，而无需为患者创造额外的工作 医疗团队或需要额外的人员。 MDC 是一种多方面的患者门户干预措施，旨在 帮助患者更好地了解他们的糖尿病健康数据，并促进和支持自我管理。 MDC 由范德比尔特大学医学中心 (VUMC) 开发，使用信息图表来方便用户 了解他们的糖尿病健康数据，纳入激励策略和访问在线 患者支持社区，并提供适合识字水平和量身定制的糖尿病自我护理信息。 为了确保互操作性并优化可扩展性，我们使用可替代医疗应用程序构建了 MDC， 快速医疗保健互操作性资源上的可重用技术（FHIR 上的 SMART）允许 MDC 安装到美国各地的各种 EHR 平台中。我们的初步研究表明 MDC 是 可接受的、可行的，提高对糖尿病健康措施的理解，并提高患者的积极性。 拟议研究的目标是：（1）将 MDC 对用户糖尿病健康数据的显示范围扩大到 血红蛋白 A1C、血压、胆固醇和流感疫苗接种状况，包括微量白蛋白和 BMI 以及 通过创建西班牙语版本来增强访问权限； (2) 评估扩展和增强的效果 MDC 版本关于糖尿病相关结果，同时通过将其集成到另一个版本来展示其可扩展性 卫生系统，并在民族和种族多样化的国家中进行务实的随机对照试验 (3) 通过研究因果介质来检验 MDC 的影响是如何产生的。拟议的 工作很重要，因为少数种族/族裔和健康素养有限的人更有可能 经历糖尿病自我护理和技术使用的障碍。通过设计、测试和评估，MDC 不同的患者群体，包括健康素养有限和正在学习西班牙语的患者 版本中，我们将加深对如何创建面向患者的健康技术以实现 广泛接受并解决健康不平等问题。通过利用 FHIR 上的 SMART，我们的项目还将展示 通过实施和测试 MDC 来达到当前的技术水平，而无需重建它，并将作为 未来基于患者门户的干预措施的模型。