Enhancing patient activation in diabetes care using social and goal-based comparisons

使用社会和基于目标的比较增强患者在糖尿病护理中的积极性

• 批准号: 9122410
• 负责人: William Martinez
• 金额: $ 16.86万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9122410
• 关键词: Advocate; American; Attitude; Award; Behavior; Behavioral; Behavioral Sciences; Blindness; Caring; Chronic; Clinic; Clinical; Clinical Sciences; Cognitive; Complications of Diabetes Mellitus; Data; Development Plans; Diabetes Mellitus; Diabetic Retinopathy; Distress; Environment; Expenditure; Funding; Future; Goals; Guidelines; Health; Health Status; Health behavior; Healthcare; Heart Diseases; Intervention; Intervention Studies; K-Series Research Career Programs; Kidney Failure; Knowledge; Laboratories; Learning; Lower Extremity; Measures; Medical; Medical Records; Mentors; Mentorship; Motivation; National Institute of Diabetes and Digestive and Kidney Diseases; Online Systems; Outcome; Patient Education; Patients; Perception; Pharmaceutical Preparations; Physicians; Primary Care Physician; Qualitative Methods; Quality of Care; Randomized Controlled Trials; Reaction; Reporting; Research; Research Methodology; Resources; Self Care; Self Management; Self Perception; Social Power; Social Psychology; Statistical Methods; Stroke; Test Result; Testing; Translational Research; United States; United States National Institutes of Health; Visit; arm; base; behavior influence; behavioral health; biomedical informatics; career; career development; control trial; cost; dashboard; design; diabetes management; experience; falls; financial incentive; health care quality; health information technology; improved; improved outcome; limb amputation; literacy; meetings; multidisciplinary; novel; peer; psychologic; screening; skills; social; translational study; treatment planning; web portal; willingness

 DESCRIPTION (provided by applicant): In the United States, diabetes is the leading cause of kidney failure, non-traumatic lower limb amputations, and new cases of blindness, and a major cause of heart disease and stroke. In addition, diabetes takes a large financial toll resulting in $116 billion in medical expenditures annually. Meeting target health outcomes (such as HgbA1C values) set by national quality of care standards (e.g., American Diabetes Association Standards of Care) reduces complications. Despite the evidence supporting the importance of these guidelines, many patients have measures of diabetes health status that fall outside of these standards. Diabetes is a self-managed condition that requires patient involvement in planning and treatment. Patient activation (i.e., willingness and ability to take action to manage one's health and healthcare) is essential to achieving diabetes management that meets national quality of care standards and is associated with lower costs. While a growing number of intervention studies aim to increase patient activation, many limitations and gaps exist. Studies looking at the impact of web-based interventions have shown promise, but evidence of their efficacy is limited and controlled trials, in particular, are needed to identify effective, sustainble, and scalable strategies to increase patient activation and assist patients in effectively managing their diabetes. In hopes of more actively involving patients in their care, many healthcare organizations have begun to routinely provide patients access to laboratory test results, medication lists, and visit summaries through patient portals, some even provide unfettered access to the notes and other documents in the medical record. However, knowledge of one's actual and target health outcomes (such as HgbA1C values) alone has been insufficient in increasing the confidence and motivation necessary to improve patients' diabetes self- management, and strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes. The power of social and goal-based comparisons (i.e., comparisons of one's own status to the status of others as well as goal status) to influence behavior is well documented in a variety of settings. Despite evidence that social comparison information increases motivation and is central to the patient experience, it has been underutilized to motivate and maintain healthy behaviors in patients with diabetes and other chronic medical conditions. This proposal describes a career development plan that enables me to gain expertise in behavioral science and quality improvement research among patients with diabetes, develop a novel diabetes dashboard for patients that contains social and goal-based comparison information about their diabetes health status, and learn valuable health information technology and research methodology for future implementation studies. The Specific Aims of the research are (1) Assess patients' attitudes, perceptions, and reactions to receiving information about their diabetes health status (e.g., HgbA1C, diabetic retinopathy screening status) relative to both national quality of care standards (i.e., goal-based information) as well as the diabetes health status of patient peers within the same medical practice (i.e., social comparison information), (2) Develop an effective diabetes dashboard for patients to illustrate measures of their diabetes health status relative to both national quality of care standards as well as the diabetes health status of patient peers within the same medical practice, and (3) Conduct a pilot, cluster randomized controlled trial (RCT) of the diabetes dashboard developed in Aim 2. The career development plan integrates: (a) advanced coursework in behavioral science, health information technology, and intervention research, (b) participation in local/national meetings, (c) a multidisciplinary mentored research experience, and (d) a highly supportive research environment. This environment includes an NIH-NIDDK funded Center for Diabetes Translation Research, a distinguished Department of Biomedical Informatics, an NIH funded Clinical and Translational Science Award, and mentorship from internationally recognized experts in behavioral science, diabetes care, and quality improvement. Overall, this career development award will advance my career in diabetes-related behavioral and quality research. In addition, the award will provide critical support to guide translational studies/R01 applications. Future studies will (a) assess the impact of the dashboard on patient activation and cognitive, behavioral, and clinical outcomes in large RCT, (b) incorporate the dashboard into a patient portal and assess the user experience, and (c) determine whether financial incentives to patients for achieving or maintaining goal status on measures of diabetes health status contained in the dashboard is superior to the dashboard alone.

 描述（由申请人提供）：在美国，糖尿病是肾衰竭、非创伤性下肢截肢和新失明病例的主要原因，也是心脏病和中风的主要原因。尽管达到国家护理质量标准（例如美国糖尿病协会护理标准）设定的目标健康结果（例如 HgbA1C 值）会减少并发症，但每年造成的医疗支出高达 1160 亿美元。尽管有证据支持这些指南的重要性，但许多患者的糖尿病健康状况指标超出了这些标准。糖尿病是一种自我管理的疾病，需要患者参与计划和治疗（即愿意和有能力接受治疗）。虽然越来越多的干预研究旨在提高患者的积极性，但仍存在许多局限性和差距。基于网络的干预措施的影响已经显现但其功效的证据有限，尤其需要对照试验来确定有效、可持续和可扩展的策略，以提高患者的积极性并帮助患者有效管理糖尿病，以期让患者更积极地参与其护理。许多医疗机构已经开始通过患者门户定期为患者提供实验室检查结果、药物清单和就诊摘要，有些甚至提供不受限制的访问病历中的笔记和其他文件，但了解患者的实际情况和目标。健康结果（例如仅靠 HgbA1C 值不足以增加改善患者糖尿病自我管理所需的信心和动力，向患者提供信息的策略必须与其他行为策略相结合，以激励和帮助患者有效管理糖尿病的社会和目标。尽管有证据表明社会比较信息可以增加动机并且对患者体验至关重要，但基于影响行为的比较（即，将自己的状态与他人的状态以及目标状态进行比较）已在各种环境中得到充分记录。它一直该提案描述了一项职业发展计划，使我能够获得糖尿病患者行为科学和质量改进研究方面的专业知识，为患者开发一种新颖的糖尿病仪表板。包含有关其糖尿病健康状况的社会和基于目标的比较信息，并为未来的实施研究学习有价值的健康信息技术和研究方法。该研究的具体目标是（1）评估患者对接收信息的态度、看法和反应。关于他们的糖尿病健康状况（例如， HgbA1C（糖尿病视网膜病变筛查状态）相对于国家护理质量标准（即基于目标的信息）以及同一医疗实践中患者同伴的糖尿病健康状况（即社会比较信息），(2) 制定为患者提供有效的糖尿病仪表板，以说明其糖尿病健康状况相对于国家护理质量标准以及同一医疗实践中患者同伴的糖尿病健康状况的衡量标准，以及 (3) 进行试点、整群随机对照试验目标 2 中开发的糖尿病仪表板的随机对照试验 (RCT)。职业行为发展计划整合了：(a) 科学、健康信息技术和干预研究方面的高级课程，(b) 参加地方/国家会议，(c) 多学科这个环境包括 NIH-NIDDK 资助的糖尿病转化研究中心、杰出的生物医学信息学系、NIH 资助的临床和转化科学奖、以及总体而言，该职业发展奖将促进我在糖尿病相关行为和质量研究方面的职业生涯，此外，该奖项还将为指导转化研究/R01 申请提供重要支持。未来的研究将（a）在大型随机对照试验中评估仪表板对患者激活以及认知、行为和临床结果的影响，（b）将仪表板纳入患者门户并评估用户体验，以及（c）确定财务是否激励患者实现或维持糖尿病健康指标的目标状态仪表板中包含的状态优于单独的仪表板。