Implementation Outcomes of a Health IT Program For Vulnerable Diabetes Patients

针对弱势糖尿病患者的健康 IT 计划的实施结果

• 批准号: 8173500
• 负责人: MARGARET Anne HANDLEY
• 金额: $ 10万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-11 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8173500
• 关键词: Implementation; Outcomes; Health; Program; Vulnerable; Implementation; Outcomes; Health; Program; Vulnerable

DESCRIPTION (provided by applicant): Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We propose to evaluate the fidelity of implementation of an innovative health information technology (Health IT) intervention for patients with chronic disease, the Automated Telephone Support Program (ATSM) developed to reach vulnerable populations with diabetes. We have developed and studied ATSM in efficacy and effectiveness trials, finding ATSM is associated with improvements in multiple diabetes-related outcomes. ATSM has received national attention, and is aligned with the national health care reform policy focus on determining how best to deploy health IT to deliver effective health care at low cost to large sectors of the US population. Based on the growing interest, it is critical to examine factors associated with ATSM implementation that may impact its wider adoption. ATSM is a complex intervention that employs phone technology to provide patient surveillance and education and to prioritize further telephone care management efforts for those most in need. ATSM innovation relates to its: (1) integration of electronic information into ongoing clinical care, to improve quality and efficiency of care delivery; and (2) effective health communication tailoring, by care managers over the telephone, for the provision of literacy or language-tailored support counseling. We have provided ATSM in a 'real world' implementation study, with AHRQ funding, in partnership with a regional health plan, the San Francisco Health Plan (SFHP). We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase its adoption. Specifically, we will use a modified Conceptual Framework for Evaluating Implementation Fidelity to organize essential ATSM delivery components. We will use this framework to structure a detailed data-based assessment of fidelity measures (e.g. frequency, content, and duration of ATSM delivery), and measures related to proposed moderating factors to ATSM delivery (e.g. representativeness of participants vs. non- participants, and quality of care management calls). We will work with SFHP to analyze the extensive data collected for the ATSM program, and to develop a User Guide that may inform other organizations considering scaling up similar health IT interventions. There is scant literature on how to adapt complex health IT interventions, such as ATSM, to local health systems needs. Examining the fidelity of implementation of such a program, describing adaptations that were made to improve adoption, and examining how adaptations and moderators will provide relevant necessary information. These findings can move forward the field of diabetes care, provide timely information on processes of adoption critical to implementation planning, and serve as a model for evaluating other complex health IT interventions. This R03 serves as an essential component to developing an evidence base to inform the scaling up health IT innovations such as ATSM. PUBLIC HEALTH RELEVANCE: Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We have developed and found successful in efficacy studies, a health IT innovation that is tailored to patient language and literacy needs, and are completing a study of its effectiveness in a 'real world' translational research trial, with a local Medicaid managed care plan. We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase adoption. This information can inform efforts underway in national health reform, to scale up health IT interventions to off-set growing chronic disease care costs.

描述（由申请人提供）：糖尿病是一个主要的公共卫生问题，对包括种族和少数民族在内的弱势群体，包括较低的社会经济地位和健康素养较低的人的人群不成比例。我们建议评估针对患有慢性疾病的患者的创新健康信息技术（健康IT）干预的实施的保真度，即自动电话支持计划（ATSM）开发了旨在吸引患有糖尿病脆弱人群的人。我们已经开发并研究了功效和有效性试验中的ATSM，发现ATSM与多种糖尿病相关结果的改善有关。 ATSM受到了全国关注，并且与国家医疗保健改革政策的重点是确定如何最好地部署健康IT以低成本为美国人口的大型部门提供有效的医疗保健。基于日益增长的兴趣，研究与ATSM实施相关的因素可能会影响其更广泛的采用。 ATSM是一项复杂的干预措施，它采用电话技术来提供患者监视和教育，并为最需要的人提供进一步的电话护理管理工作。 ATSM创新与其：（1）将电子信息集成到正在进行的临床护理中，以提高护理的质量和效率； （2）护理经理通过电话进行有效的健康沟通量身定制，以提供识字或语言范围的支持咨询。我们在“现实世界”实施研究中提供了ATSM，并与AHRQ资助与区域健康计划，即旧金山健康计划（SFHP）合作。我们建议在此R03中研究干预措施实施的忠诚度，并检查为增加采用的适应性。具体来说，我们将使用修改后的概念框架来评估实施保真度以组织基本ATSM交付组件。我们将使用此框架来构建基于数据的忠诚度度量（例如频率，内容和持续时间ATSM交付的持续时间）的详细评估，以及与提议的调节因素有关的措施（例如，参与者与非参与者的代表性与非参与者的代表性，以及护理管理质量的质量）。我们将与SFHP合作，分析为ATSM计划收集的大量数据，并开发一份用户指南，该指南可能会告知其他组织考虑扩大类似健康IT干预措施的组织。关于如何将复杂健康IT干预（例如ATSM）适应当地卫生系统需求的文献很少。检查实施此类计划的忠诚度，描述为改善采用而进行的适应，并研究适应和主持人将如何提供相关的必要信息。这些发现可以推进糖尿病护理领域，提供有关对实施计划至关重要的采用过程的及时信息，并作为评估其他复杂健康IT干预措施的模型。该R03是建立证据基础以告知扩大健康IT创新（例如ATSM）的重要组成部分。 公共卫生相关性：糖尿病是一个主要的公共卫生问题，对包括种族和少数民族在内的弱势群体（包括较低的社会经济地位和健康素养较低的人）的脆弱人群不成比例。我们已经开发并发现了在疗效研究中成功的成功，这是针对患者语言和识字需求量身定制的健康IT创新，并通过当地的Medicaid托管护理计划完成了对“现实世界”翻译研究试验中其有效性的研究。我们建议在此R03中研究干预措施实施的忠诚度，并检查为增加采用而进行的改编。这些信息可以为国家卫生改革的努力提供信息，以扩大健康IT干预措施，以偏离慢性病护理成本。