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.

项目概要/摘要 循证糖尿病监测和预防服务可以预防或推迟许多成本高昂且成本高昂的糖尿病监测和预防服务。 与疾病相关的病态并发症，但许多患者并未接受所有具有临床意义的证据- 例如，检测和治疗早期糖尿病眼病可以减少糖尿病眼病的发生。 据估计 60% 的人会出现严重视力丧失，大约 40% 的美国人患有糖尿病 之前的研究表明，接受年度眼科检查存在许多障碍。 基于证据的糖尿病监测和预防服务，包括患者因素（例如，缺乏认识） 和有限的健康素养）和临床医生/系统因素（例如，有限的医生时间和患者支持之间 加强糖尿病监测和预防服务的尝试收效甚微。 为了实现这些服务的最佳费率，迫切需要采取干预措施来提高临床效率 减少临床医生的工作量，适合不同健康素养水平的患者，并且具有较高的疗效 通过提供一种有吸引力且便捷的方式来跟踪和可视化健康数据， 获得教育和指导、接收通知以及连接患者和医生，患者门户提供了 有前景的平台，可以增强获得卫生服务的机会，同时克服昂贵和困难的限制 我们的研究团队之前应用了以用户为中心的设计冲刺。 开发患者门户特性和功能的方法，这些特性和功能对不同的人群有吸引力和满意 糖尿病患者群体使用，让用户更好地了解自己的糖尿病健康状况 用户的反馈表明他们希望自助订购和自助安排服务。 使用类似的方法并在强有力的机构认可下，我们将进行设计、可用性测试、 并评估一种新颖的患者门户干预措施，以：（a）在选择时通知患者，具有临床意义， 基于证据的糖尿病监测和预防服务（例如年度眼科检查）到期并提供 提醒及时完成，(b) 通过以下方式促进对这些服务重要性的理解： 识字敏感内容，以及 (c) 允许患者在基于证据的指南到期时“自行订购” （需要初级保健医生 (PCP) 单击共同签名）实验室测试（例如 A1C）和疫苗之前 具体来说，我们的目标是：（1）应用设计 Sprint 方法和可用性测试来设计和测试患者门户干预（如上所述）， 可以克服患者和临床医生/系统的障碍，完成基于证据的、有临床意义的、 在不同的患者群体中提供糖尿病监测和预防服务，(2) 评估治疗的效果 目标 1 中制定的患者门户干预措施是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 的态度和经历， 关于干预措施的可接受性和有用性及其对临床效率的影响。