An Assessment of Open Access Audio of the Clinical Encounter on Veterans and their Care

对退伍军人临床遭遇及其护理的开放获取音频的评估

• 批准号: 10062627
• 负责人: SAUL J. WEINER
• 金额: --
• 依托单位: JESSE BROWN VA 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: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10062627
• 关键词: Accident and Emergency department; Address; Adherence; Adopted; Adoption; Anxiety; Appointment; Assessment tool; Attention; Awareness; Behavior; Blinded; Blood Pressure; Caregivers; Caring; Chronic; Chronic Disease; Clinic; Clinical; Code; Communication; Comparison arm; Complex; Confidentiality of Patient Information; Conflict (Psychology); Data; Devices; Diabetes Mellitus; Disease; Effectiveness; Emergency department visit; Family; Fibrinogen; Focus Groups; Foundations; Funding; General Practitioners; Glycosylated Hemoglobin; Health; Healthcare; Healthcare Systems; Hospitalization; Individual; Inpatients; Instruction; Internet; Interview; Lead; Leadership; Legal; Life; Measures; Mediating; Medical; Medical Care Team; Methodology; Movement; Nature; Oncologist; Outcome; Participant; Patients; Perception; Performance; Pharmaceutical Preparations; Physicians; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Readiness; Reporting; Research; Research Design; Resources; Risk; Safety; Secure; Self Management; Specialist; Specific qualifier value; Structure; Surveys; System; Technology; Telephone; Testing; Thinking; Time; Veterans; Visit; Work; arm; base; biomedical data science; care outcomes; clinical encounter; clinically relevant; communication behavior; connected care; connected health; contextual factors; cost; data warehouse; design; experience; follow-up; health care service organization; improved; innovation; interest; legal implication; medical specialties; member; new technology; next generation; open innovation; patient portal; programs; provider behavior; secondary analysis; service utilization; stressor; tool; treatment adherence; treatment planning; trial design

Background: The medical encounter can be overwhelming in term of the amount of information discussed, its technical nature, and the anxiety it can generate. Easy access to a secure audio recording from any internet enabled device is an available low cost technology that allows patients to “revisit the visit” either alone or sharing with caretakers and family. It has been introduced and tested outside the VA with evidence that it increases patient recall and understanding and may even improve physician performance. Little is known, however, about whether and to what extent these effects lead to better outcomes, such as improved treatment plan adherence and chronic disease self-management. Significance/Impact: This study will assess a new resource for enhancing Veterans capacity to understand their care plan, and share information from their visit with caregivers. The study design is intended to yield information to guide decision makers about the value of bringing “open access audio” (OAA) to VHA. Innovation: The Open Chart movement, in which patients can freely access their written medical information was a major innovation first introduced through the patient portal in 2010, and is rapidly disseminating-- including within VHA. OAA extends the same principles of full transparency and easy access to medical information and, if successful, could also be incorporated into the patient portal. The VHA Office of Connected Care, which manages MyHealtheVet has indicated interest in this project because of its potential to transform the next generation portal. Specific Aims: This study will access, using a randomized controlled trial design, whether the known benefits of OAA (better patient recall and understanding) lead to several desired service utilization and health care outcomes. It will also measure the effect of OAA on provider behaviors that may mediate those outcomes. Throughout, data will be collected on participant and other stakeholder perceptions of the program that, based on prior research on audio- recording in the clinical setting, reflect a readiness to adopt the new technology. Aim 1: Assess the impact of an open access audio program on two behaviors (patient activation, treatment plan adherence), and two chronic condition measures (glycosylated hemoglobin, blood pressure). Secondary analysis will descriptively measure effect size on ED visits and hospital admissions. Aim 2: Assess the impact of open access audio on provider communication and on their attention to patient contextual factors (i.e. individual Veterans needs and circumstances relevant to planning effective care). Aim 3: Assess patient, provider, and leadership perceptions of the extent to which the program is safe, not burdensome, and worthwhile at both the start and at two years into the program. Methodology: The setting will be primary care and diabetes clinics, at two facilities for generalizability. To achieve aims 1 and 2, we propose a randomized controlled three arm design: (1) the encounter is recorded, with provider and patient aware, and uploaded to a server the Veteran, provider, and research team can access post visit; (2) the encounter is recorded, with both parties aware, and uploaded to a server only the research team can access; and (3) the encounter is recorded, with only the patient aware, and uploaded to a server only the research team can access. Resource utilization and disease measures indicated in aims 1 and 2 will be collected in all arms. Comparisons of Arms “1” and “2” enable assessing the impact of the availability of audio on patients (for aim 1). Comparisons of Arm “2” with “3” enables isolating the effect of providers knowing they are being recorded (for aim 2). Data for aim 3 will come from survey tools, focus groups and semi-structured leadership interviews to elicit perceptions of project safety, burden, and value. Next Steps/Implementation: We will work with the Office of Connected Health to identify opportunities, based on the findings for incorporating Open Audio Access into the next generation patient portal.

背景：就讨论的信息量而言，医疗遭遇可能是压倒性的，其 技术性质，以及它可能产生的焦虑，可以从任何互联网轻松访问安全的录音。 启用的设备是一种可用的低成本技术，允许患者单独或“重访” 与看护者和家人共享它已在 VA 之外进行了介绍和测试，并有证据表明它有效。 增加患者的记忆和理解，甚至可能提高医生的表现，但目前所知甚少。 然而，这些影响是否以及在多大程度上会带来更好的结果，例如改善 治疗计划依从性和慢性病自我管理。 意义/影响：本研究将评估一种新资源，以增强退伍军人的理解能力 他们的护理计划，并与护理人员分享他们的访问信息 该研究设计旨在产生成果。 指导决策者了解将“开放获取音频”(OAA) 引入 VHA 的价值的信息。 创新：开放图表运动，患者可以自由访问他们的书面医疗信息 是 2010 年通过患者门户首次推出的一项重大创新，并且正在迅速传播—— 包括在 VHA 内，OAA 也延续了完全透明和轻松获得医疗服务的相同原则。 信息，如果成功，还可以纳入 VHA 办公室的患者门户。 管理 MyHealtheVet 的 Connected Care 表示对该项目感兴趣，因为它具有潜力 改造下一代门户。 具体目标：本研究将使用随机对照试验设计来了解以下药物的已知益处： OAA（更好的患者回忆和理解）可带来多种期望的服务利用和医疗保健结果。 还将衡量 OAA 对可能调解这些结果的提供商行为的影响。 收集参与者和其他利益相关者对该计划的看法，这些看法基于先前对音频的研究 在临床环境中进行记录，反映了采用新技术的准备。 目标 1：评估开放获取音频节目对两种行为（患者激活、治疗 计划依从性）和两项慢性病指标（糖化血红蛋白、血压）。 二次分析将描述性地衡量对急诊就诊和入院的影响大小。 目标 2：评估开放获取音频对提供者沟通及其对患者关注的影响 背景因素（即与规划有效护理相关的退伍军人个人需求和情况）。 目标 3：评估患者、提供者和领导层对该计划安全程度的看法，而不是 在该计划的开始和两年后都是繁重的，但值得的。 方法：设置将是初级保健和糖尿病诊所，在两个设施中以实现普遍性。 为了实现目标 1 和 2，我们提出了一种随机控制的三臂设计：（1）记录遭遇， 提供者和患者都了解，并上传到服务器，退伍军人、提供者和研究团队可以 访问后访问；(2) 在双方均知情的情况下记录该遭遇，并仅将其上传到服务器 研究团队可以访问；(3) 在只有患者知情的情况下记录这次遭遇，并将其上传到 只有研究团队可以访问目标 1 中所示的资源利用和疾病测量。 和 2 将在所有组中收集 比较组“1”和“2”可以评估该组的影响。 患者身上音频的可用性（对于目标 1），比较臂“2”与“3”可以隔离音频的影响。 提供者知道他们正在被记录（针对目标 2）。目标 3 的数据将来自调查工具、焦点。 小组和半结构化领导访谈，以了解项目安全、负担和价值的看法。 后续步骤/实施：我们将与互联健康办公室合作，寻找机会， 基于将开放音频访问纳入下一代患者门户的研究结果。