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; 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（由适用提供）：在美国，糖尿病是肾衰竭，非创伤下肢截肢和新的失明病例的主要原因，也是心脏病和中风的主要原因。此外，糖尿病会给大量财务投资带来巨大的财务损失，每年获得1,160亿美元的医疗支出。满足目标健康成果（例如HGBA1C值），由国家护理标准（例如，美国糖尿病协会的护理标准）设定的降低并发症。尽管有证据支持这些准则的重要性，但许多患者的糖尿病健康状况措施范围不在这些标准之外。糖尿病是一种自我管理的疾病，需要患者参与计划和治疗。患者激活（即采取行动来管理自己的健康和医疗保健的意愿和能力）对于实现符合国家护理标准的糖尿病管理至关重要，并且与较低的成本有关。尽管越来越多的干预研究旨在增加患者的激活，但存在许多局限性和差距。研究基于Web的干预措施的影响的研究表明了其有效性的证据是有限的，尤其是对照试验，以确定有效，可持续和可扩展的策略，以增加患者的激活并帮助患者有效地管理其糖尿病。为了希望有更多积极参与患者的护理患者，许多医疗保健组织已开始常规地为患者提供实验室测试结果，药物清单的访问权限，并通过患者门户网站访问摘要，甚至有些人甚至不受约束地访问病历中的票据和其他文件。但是，仅了解一个人的实际和目标健康结果（例如HGBA1C值），不足以提高改善患者糖尿病自我管理所需的信心和动力，以及为患者提供信息的策略，必须与其他行为策略相结合，以激发动机并帮助患者有效地管理糖尿病。在各种环境中，都很好地记录了基于社会和基于目标的比较（即对他人身份以及目标状态的比较以及目标状态的比较）。尽管有证据表明社会比较信息增加了动力，并且对患者的体验至关重要，但它的未经充分利用而无法成熟并保持糖尿病患者和其他慢性病患者的健康行为。该提案描述了一项职业发展计划，使我能够在糖尿病患者的行为科学和质量改善研究方面获得专业知识，并为患者开发一种新型的糖尿病仪表板，其中包含有关其糖尿病的社交和基于目标的比较信息。健康状况，并学习有价值的健康信息技术和研究方法，以进行未来的实施研究。该研究的具体目的是（1）评估患者的吸引力，感知和对接收有关其糖尿病健康状况的信息（例如，HGBA1C，糖尿病性视网膜病变筛查状态）相对于国家护理标准的质量（即基于目标的信息）以及糖尿病在糖尿病的健康状况（以及与糖尿病的健康惯例（即社交）（即社交）相比，即社交（即社交）（即社交），患者的仪表板说明其糖尿病健康状况相对于国家护理标准质量以及患者同伴在同一医疗实践中的糖尿病健康状况的措施，以及（3）进行飞行员，集群随机对照试验（RCT）的糖尿病dashboard dashboard在AIM 2中开发的dashboard dashboard的仪表板。会议，（c）多学科的指导研究经验，以及（d）高度支持的研究环境。这种环境包括NIH-NIDDK糖尿病翻译研究中心，杰出的生物医学信息学系，NIH资助的临床和转化科学奖，以及国际公认的行为科学，糖尿病护理和质量改善的国际知名专家。总体而言，该职业发展奖将推动我在与糖尿病有关的行为和质量研究方面的职业发展。此外，该奖项将为指导翻译研究/R01应用提供重要支持。未来的研究将（a）评估仪表板对大型RCT的患者激活和认知，行为和临床结果的影响，（b）将仪表板纳入患者门户网站并评估用户体验，以及（c）确定对患者的经济激励措施是否在dashboard板中不可能实现或维持糖尿病健康状况的目标状态，以实现或维持其目标。