For the more than 100 million patients with chronic conditions in the United States, collaborating with their health care team is part of effective, high-quality care. Internet health resources and communication can be an important element in improving care, as suggested by the Chronic Care Model. The model's keystone may be information technology that supports provider documentation and communication, as well as web-based patient self-management, education, and health communication;such technology can enable patient activation and self-management. Nationally, 50 percent of patients with chronic disease use the internet. However, little information is available on what promotes or is a barrier to use of internet health resources, or its effect on the consumer. To that end, we propose to examine these promoters and barriers, as well as the association of use with disease outcomes. We will develop a practical measure of the readiness of ambulatory patients with chronic conditions to use web-based health resources, test the predictive validity of the measure against logs of actual use of these resources by these same patients, and directly observe their use of these resources (Aim 1). We will examine how use of web-based resources is associated with clinical outcomes for patients with diabetes (Aim 2). This rich examination of preferences for use of web-based health resources among ambulatory patients with chronic disease will inform projects, systems, and policies that seek to use the online environment as part of a comprehensive disease management strategy. Although Dr. Koopman is experienced in the area of chronic disease research, the profound importance of this topic and the need for new skills in this area led her to the proposed Career Development Award as an important step toward future translational research. Dr. Koopman will leverage her established relationship with her mentor, Dr. David Mehr, and his currently funded AHRQ work "Using Health IT to Improve Ambulatory Chronic Disease Care" (1R18HS017035-01), which aims to evaluate the effectiveness of a new web-based interactive patient health portal. In addition to the proposed research, this application's structured career development plan includes supplementary training in instrument development and human- computer interaction, as well as scientific and career guidance from a multidisciplinary advisory committee and continued training in the responsible conduct of research. If awarded, Dr. Koopman's department and institution pledge that 75% of her time will be devoted to these research and career development activities. This Career Development Award will allow Dr. Koopman to gain expertise in scale development and in human computer interaction. This expertise will inform the research proposed, to identify promoters and barriers to the use of internet health resources by ambulatory patients with chronic conditions. She will also investigate how use of internet health resources is associated with disease outcomes. This knowledge will inform projects, systems, and policies seeking to use the online environment to improve care for patients.
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