Leveraging Heath Information Technology to Improve Post-Discharge Management for Patients with Heart Failure

利用健康信息技术改善心力衰竭患者的出院后管理

• 批准号: 10592045
• 负责人: Eun Ji Kim
• 金额: $ 19.17万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592045
• 关键词: Address; Applications Grants; Behavior Therapy; Behavioral Sciences; Cardiovascular system; Caring; Cellular Phone; Clinical; Clinical Investigator; Computers; Effectiveness; Failure; Feedback; Focus Groups; Foundations; Goals; Health; Health system; Heart failure; Homelessness; Hospitalization; Hospitals; Individual; Intervention; K-Series Research Career Programs; Knowledge; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Monitor; Nurses; Outcome; Patient Care; Patient Triage; Patients; Perception; Physicians; Positioning Attribute; Randomized; Randomized, Controlled Trials; Research; Research Activity; Research Personnel; Research Project Grants; Research Project Summaries; Resources; Risk; Sample Size; Services; Technology; Testing; Text; Text Messaging; Time; Training; Training Activity; Transcript; Use Effectiveness; Work; automated text message; career; experience; group intervention; health care service utilization; health information technology; health literacy; hospital readmission; implementation science; improved; insight; low health literacy; patient handout; patient navigator; poor health outcome; posthospitalization care; power analysis; prototype; screening program; skills; social; social health determinants; text messaging intervention; theories; tool; trial design; uptake; usability; usual care arm

Project Summary My long-term career goal is to become a clinician investigator, who uses health information technology (IT) to improve cardiovascular outcomes among patients with social needs. The research goal of this application is to use health IT to reduce preventable readmissions for heart failure (HF) among patients with low health literacy with the incorporation of behavioral science and usability testing. Social determinants of health (SDH) account for 80% of health outcomes, and social needs are associated with poor health outcomes, including 30-day readmissions. Addressing individuals’ social needs has been associated with improved clinical outcomes, but may take a prolonged time to effectively reduce 30-day readmissions. Health literacy, which measures a patient’s ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, is associated with patients’ health outcomes. Low health literacy is common among patients with HF, and leads to poor management of HF. Extant interventions, such as patient navigators and handouts, have been utilized successfully to improve medical care for patients with low health literacy, but they are episodic and resource-intensive. The use of health IT tools, such as a personalized, automated text-message-based application, can be utilized for post-hospitalization care. Our preliminary study indicates that patients with HF who use this application had reduced 30-day readmissions, compared to patients with HF who did not use the application. However, the number of patients with HF using the application has been limited, due to low uptake and high attrition rate. The overall objective of the proposed research project is to incorporate nudges, and address barriers to improve patients’ use of the application, and conduct a pilot randomized controlled trial (RCT) to evaluate the application’s use in reducing 30-day readmissions. We will conduct qualitative work to gain insights into how to adapt an extant text messaging intervention to improve its use among patients with low health literacy (Aim 1), conduct usability testing and iterative revision of the application (Aim 2), and conduct a pilot RCT to evaluate the acceptability, feasibility, and preliminary efficacy of using behavioral interventions to increase the application use for patients with HF post-discharge (Aim 3). The training from this mentored career development award will provide skills in four domains: 1) behavioral science; 2) implementation science; 3) health literacy; and 4) RCT design and conduct. The proposed research activities, and the training and mentoring plans will provide the foundation for my career as an independent clinician investigator.

项目概要 我的长期职业目标是成为一名临床调查员，利用健康信息技术 (IT) 来 改善有社会需求的患者的心血管结局 该应用的研究目标是 使用卫生信息技术减少健康素养较低的患者因心力衰竭 (HF) 而发生的可预防的再入院 结合了行为科学和可用性测试。健康的社会决定因素 (SDH) 账户。 80% 的健康结果，而社会需求与不良健康结果相关，包括 30 天 解决个人的社会需求与改善临床结果有关，但是 可能需要较长时间才能有效减少 30 天再入院率，该指标衡量的是 患者查找、理解和使用信息和服务来做出与健康相关的决策的能力 为自己和他人采取的行动与患者的健康结果相关，健康素养低下是很常见的。 心力衰竭患者，并导致现有干预措施（例如患者）管理不善。 导航器和讲义已成功用于改善健康状况不佳患者的医疗护理 识字，但它们是间歇性的和资源密集型的。 基于自动短信的应用程序，可用于我们的初步研究。 表明使用该应用程序的心力衰竭患者 30 天再入院率比 未使用该应用程序的心力衰竭患者 然而，使用该应用程序的心力衰竭患者数量。 由于采用率低和流失率高，应用受到限制。 拟议的总体目标。 研究项目旨在整合推动因素并解决障碍，以改善患者对应用程序的使用，以及 进行试点随机对照试验 (RCT)，以评估该应用程序在缩短 30 天时间方面的用途 我们将进行定性工作，以深入了解如何调整现有的短信。 干预措施以改善其在健康素养较低的患者中的使用（目标 1），进行可用性测试和 对应用程序进行迭代修订（目标 2），并进行试点 RCT 来评估可接受性、可行性、 以及使用行为干预增加心力衰竭患者应用程序使用的初步效果 出院后（目标 3），该指导性职业发展奖的培训将提供四项技能。 领域：1) 行为科学；2) 实施科学；3) 健康素养；4) 随机对照试验的设计和实施。 拟议的研究活动以及培训和指导计划将为我的研究奠定基础 作为独立临床医生调查员的职业生涯。