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 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.