This is an application for a K08 Mentored Clinical Scientist Development Award for Dr. Neda Ratanawongsa, an Assistant Adjunct Professor in General Internal Medicine at the University of California, San Francisco, who is establishing herself as a young investigator in health informatics implementation research. This K08 award with provide her with the necessary support to tailor an objective measure of medication adherence for use in a safety net health care system and integrate this measure into a safety net electronic health record system to promote more patient-centered treatment decision-making. To achieve these goals, Dr. Ratanawongsa has assembled a multi-disciplinary mentoring team comprised of a primary mentor, Dr. Dean Schillinger, a renowned expert in health communication and safety net practice-based research using health information technology interventions, and three co-mentors: Dr. Andrew Karter, an health services researcher and expert in medication adherence;Dr. Julie Schmittdiel, Director for the Health Delivery Systems Center for Diabetes Translational Research and health care organizations expert in practice-based intervention research;and Dr. Glyn Elwyn, an internationally renowned expert in practice-based informatics interventions to improve shared decision-making. Public health safety net systems serve high proportions of low-income and racial/ethnic minorities with high diabetes prevalence and poor clinical outcomes. Safety net ambulatory clinics are undergoing a transformation with Medicaid expansion and widespread implementation of electronic health record systems triggered by national legislation. Dr. Ratanawongsa will leverage this unique context and data from an AHRQ R18-funded trial of diabetes self-management support implemented by a Medicaid managed care plan. Specifically, she will develop an objective and practical system to detect inadequate medication adherence in a diverse population of Medicaid managed care plan members with diabetes (Aim 1) and elucidate key communication strategies and factors that facilitate higher quality shared decision-making and improved adherence in safety net encounters for Medicaid managed care plan members (Aim 2). She will then engage patients and clinicians to develop a comprehensive multimodal intervention to provide medication refill adherence data through a safety net electronic health record decision support tool (Aim 3). Through a focused program of mentored training and coursework, the candidate will develop advanced skills in medical informatics, conversational analysis, and practice-based implementation research in safety net settings. At the completion of this award, Dr. Ratanawongsa will be well positioned to develop an R01 application to test the effectiveness of a multimodal electronic health record intervention to improve patient medication adherence, shared decision-making, and patient-important outcomes for safety net populations with chronic diseases.

Public Health Relevance

Public health safety net systems serve high proportions of low-income and racial/ethnic minorities with higher diabetes prevalence and poorer clinical outcomes. Safety net ambulatory clinics are undergoing a transformation with Medicaid expansion and widespread implementation of electronic health record systems triggered by national legislation. By engaging safety net patients and clinicians to develop an electronic health record tool to reveal and discuss patient non-adherence, drawn from Medicaid claims, this proposal has the potential to improve patient medication adherence, shared decision-making, and patient-important outcomes for safety net populations.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Clinical Investigator Award (CIA) (K08)
Project #
1K08HS022561-01
Application #
8617713
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
Project Start
2014-07-03
Project End
2018-06-30
Budget Start
2014-07-03
Budget End
2015-06-30
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Ratanawongsa, Neda (2016) Capsule Commentary on Dzeng et al., Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: a Qualitative Inquiry. J Gen Intern Med 31:108
Ratanawongsa, Neda; Barton, Jennifer L; Lyles, Courtney R et al. (2016) Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics. JAMA Intern Med 176:125-8
Tieu, Lina; Sarkar, Urmimala; Schillinger, Dean et al. (2015) Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study. J Med Internet Res 17:e275
Ratanawongsa, Neda; Karter, Andrew J; Quan, Judy et al. (2015) Reach and Validity of an Objective Medication Adherence Measure Among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study. J Manag Care Spec Pharm 21:688-98
Chao, M T; Handley, M A; Quan, J et al. (2015) Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes. Patient Educ Couns 98:1360-6
Quan, Judy; Lee, Alexandra K; Handley, Margaret A et al. (2015) Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis. Popul Health Manag 18:412-20
Gupta, Shivani; Brenner, Alison T; Ratanawongsa, Neda et al. (2014) Patient trust in physician influences colorectal cancer screening in low-income patients. Am J Prev Med 47:417-23