Social virtual reality and diabetes management: Extending the clinical encounter

社交虚拟现实和糖尿病管理：扩展临床接触

• 批准号: 7836816
• 负责人: Richard Charles Goldsworthy
• 金额: $ 88.68万
• 依托单位: ACADEMIC EDGE, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-31 至 2012-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7836816
• 关键词: Adherence; Affect; Area; Behavior; Behavior Therapy; Behavioral; Caring; Center for Translational Science Activities; Client satisfaction; Clinic Visits; Clinical; Coupled; Data; Data Analyses; Databases; Development; Diabetes Mellitus; Education; Effectiveness; Elements; Environment; Face; Feedback; Frequencies; Health Services Accessibility; Health Status; Healthcare Systems; Individual; Intake; Joints; Knowledge; Lead; Learning; Life; Life Style; Measures; Medical; Methodology; Methods; Online Systems; Outcome; Patient Care; Patients; Performance; Pharmaceutical Preparations; Physicians; Primary Health Care; Professional counselor; Provider; Psychological reinforcement; Quality of life; Recruitment Activity; Regimen; Resources; Risk; Schedule; Self Management; Simulate; Social Environment; Social Impacts; Specialist; Structure; Technology; Testing; Time; Training; Translating; United States; United States National Library of Medicine; Visit; abstracting; behavior change; care systems; comparative; comparative effectiveness; design; diabetes management; diabetic; diabetic patient; effectiveness research; electronic recording system; experience; follow-up; improved; innovation; meetings; pressure; psychosocial; research study; response; skills; social; tool; treatment as usual; virtual; virtual reality; Adherence; Affect; Area; Behavior; Behavior Therapy; Behavioral; Caring; Center for Translational Science Activities; Client satisfaction; Clinic Visits; Clinical; Coupled; Data; Data Analyses; Databases; Development; Diabetes Mellitus; Education; Effectiveness; Elements; Environment; Face; Feedback; Frequencies; Health Services Accessibility; Health Status; Healthcare Systems; Individual; Intake; Joints; Knowledge; Lead; Learning; Life; Life Style; Measures; Medical; Methodology; Methods; Online Systems; Outcome; Patient Care; Patients; Performance; Pharmaceutical Preparations; Physicians; Primary Health Care; Professional counselor; Provider; Psychological reinforcement; Quality of life; Recruitment Activity; Regimen; Resources; Risk; Schedule; Self Management; Simulate; Social Environment; Social Impacts; Specialist; Structure; Technology; Testing; Time; Training; Translating; United States; United States National Library of Medicine; Visit; abstracting; behavior change; care systems; comparative; comparative effectiveness; design; diabetes management; diabetic; diabetic patient; effectiveness research; electronic recording system; experience; follow-up; improved; innovation; meetings; pressure; psychosocial; research study; response; skills; social; tool; treatment as usual; virtual; virtual reality

DESCRIPTION (provided by applicant): There are over 24 million individuals affected by diabetes in the United States. The majority of these individuals are cared for by primary care providers (PCPs) rather than specialists. There has been significant improvement in our understanding and articulation of ideal patient and provider diabetes management practices. However, these optimal diabetes care behaviors are often not achieved in real world clinical experiences as a result of environmental and psychosocial barriers faced by providers and by patients. A significant barrier both to optimal provider practice and to optimal patient self-management and regimen adherence is "face time"-the amount of time available to the patient and provider to engage in any given clinical encounter. The short duration of typical primary care patient-provider interactions (PPIs), coupled with their relatively infrequency and erratic scheduling, presents a considerable barrier to achieving ideal diabetes management practices. In particular, extreme time pressures placed upon PCP and the common lack of support structures, often cause the focus of the diabetic PPI to shift away from important but time-intensive elements of self- management, such as lifestyle change and behavioral modification support, toward a more narrow emphasis on "fixing the numbers," with, perhaps as a result, the vast majority of patients not being treated to target. Additionally, infrequent diabetic PPIs equate to fewer opportunities to gather patient outcomes data points: providers receive less, and less frequent, data regarding their patients status and, as a result, are both less informed regarding health status progression and less able to modify the regimen for optimal management. For patients, infrequent and erratic contact with the health care system may lead to suboptimal diabetes self- management as a result of relatively inconsistent opportunities for feedback regarding and reinforcement of their medication regimen, and their lifestyle change and behavioral modification efforts. Ideally, this situation would be remedied by providing PCPs with more time for diabetic PPIs; however, for a variety of sociotechnical reasons this is unlikely to occur within the structure and pressures of the US healthcare system. Therefore, other approaches to achieving more optimal outcomes, without increasing provider and patient burden, must be explored. One innovative approach to increasing the frequency and duration of the PPI is to extend such "face time" with web-based, interactive technologies, including social virtual reality environments (SVRE). Through SVRE, aspects of ideal patient and provider diabetes management practices which are either omitted or which occur with suboptimal frequency can be conducted virtually before, after, and between face-to-face PPI. Such an extension of the clinical encounter would represent a valuable augmentation of usual care, increasing opportunities for patient outcome tracking, feedback, and reinforcement, and thereby potentially improving adherence, reducing mismanagement and sequalae, and improving patient outcomes and quality of life. Drawing on AEI's media, educational and performance support experience with a wide range of behavioral change and PCP support efforts and IUSOM's Diabetes Translational Research Center's expertise in diabetes care, access to diabetes PCP providers and patients, and well-known electronic records systems, the proposed effort will examine the impact of using SVRE to augment usual care. The effort will translate aspects of ideal PCP diabetes management care to a SVRE by carefully creating a PCP diabetes care SVRE through an established iterative user-centered development methodology. The acceptability, utility, and impact of the resulting SVRE will be examined in a controlled, mixed methods, multivariate, repeated measures field trial with follow-up conducted among diabetes patients and providers within the IUSOM medical care system. A significant barrier both to optimal provider practice and to optimal diabetes management is "face time"- the amount of time available to the patient and provider to engage in any given clinical encounter. One possible approach to increasing the frequency and duration of the PPI is to extend such "face time" with web-based, interactive technologies, including social virtual reality environments (SVRE). Such an extension of the clinical encounter would represent a valuable augmentation of usual care, increasing opportunities for patient outcome tracking, feedback, and reinforcement, and thereby potentially improving adherence, reducing mismanagement and sequalae, and improving patient outcomes and quality of life. Very little is known regarding the acceptability and impact of SVRE among diabetes patients and even less regarding the utility of patients interacting with live and simulated provider avatars. By developing a PCP diabetes care SVRE, examining patient satisfaction with the environment, and comparing patient outcomes of those in SVRE- augmented usual care with those in usual care, the proposed effort will fill this gap in our understanding, provide generalizable findings related to best practices in this arena, and potentially lead to a disseminable tool for improving diabetes patient care, outcomes and quality of life.

描述（由申请人提供）：在美国，有超过2400万人受糖尿病的影响。这些人中的大多数是由初级保健提供者（PCP）而不是专家提供的。我们对理想患者和提供者糖尿病管理实践的理解和表达方面有了显着改善。但是，由于提供者和患者面临的环境和社会心理障碍，这些最佳的糖尿病护理行为通常在现实世界中无法实现。最佳提供者实践和最佳患者自我管理和依从性的最佳障碍是“面对时间” - 患者和提供者可用于进行任何给定临床遭遇的时间。典型的初级保健患者提供者相互作用（PPI）的持续时间短，再加上其相对频率和不稳定的时间表，这给实现理想的糖尿病管理实践带来了相当大的障碍。特别是，极端的时间压力和普遍缺乏支持结构的不足，通常会​​导致糖尿病性PPI的重点从重要但耗时的自我管理元素（例如生活方式变化和行为修改支持）转向更狭窄的重点，而更加狭窄地将“固定数字”固定，也许是因为，大多数患者没有治疗目标。此外，罕见的糖尿病性PPI等同于收集患者预后的机会较少：提供者获得的有关其患者状况的数据较少，较少的数据，因此，有关健康状况进展的信息较少，并且较少了解了对健康状况的修改方案。对于患者，由于相对不一致的有关药物治疗方案的反馈和增强其生活方式的变化和行为修改工作的机会，与医疗保健系统的不常接触可能导致次优糖尿病的自我管理。理想情况下，通过为PCP提供更多的糖尿病性PPI的时间来解决这种情况。但是，由于各种社会技术原因，这不太可能在美国医疗保健系统的结构和压力中发生。因此，必须探讨其他方法来实现更最佳结果，而无需增加提供者和患者负担。一种创新的方法来增加PPI的频率和持续时间是通过基于网络的交互式技术（包括社交虚拟现实环境（SVRE））扩展这种“面部时间”。通过SVRE，可以在面对面PPI之前，之后和之间实际上进行省略或以次优频率进行的理想患者和提供者糖尿病管理实践的各个方面。这种临床遭遇的这种扩展将代表通常的护理，增加患者结果跟踪，反馈和增强的机会，从而有可能提高依从性，减少管理不善和序列，并改善患者的结果和生活质量。利用AEI的媒体，具有广泛的行为变化和PCP支持工作的教育和绩效支持经验以及IUSOM的糖尿病转化研究中心在糖尿病护理方面的专业知识，访问糖尿病PCP提供者和患者以及知名的电子记录系统，该拟议的工作将研究使用SVRE来增强经常护理的影响。这项工作将通过通过已建立的以用户为中心的迭代迭代的开发方法仔细创建PCP糖尿病护理SVRE来将理想的PCP糖尿病管理护理的各个方面转化为SVRE。由此产生的SVRE的可接受性，效用和影响将在受控的，混合的方法，多变量，重复措施现场试验中进行检查，并在IUSOM医疗保健系统中进行了随访。最佳提供者实践和最佳糖尿病管理的重大障碍是“面对时间” - 患者和提供者可用的时间进行任何给定的临床遭遇的时间。增加PPI频率和持续时间的一种可能方法是通过基于Web的交互式技术（包括社交虚拟现实环境（SVRE））扩展这种“面部时间”。这种临床遭遇的这种扩展将代表通常的护理，增加患者结果跟踪，反馈和增强的机会，从而有可能提高依从性，减少管理不善和序列，并改善患者的结果和生活质量。关于SVRE在糖尿病患者中的可接受性和影响方面，关于与现场和模拟提供者化身相互作用的患者的效用知之甚少。通过开发PCP糖尿病护理SVRE，检查患者对环境的满意度，并比较患者的临时护理与通常护理的患者的结果，拟议的努力将在我们的理解中填补这一空白，提供与该领域中最佳实践相关的可概括的发现，并有潜在地改善糖尿病的病人和良好的糖尿病，并质量良好。