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.
Meeting target health outcomes (e.g., HgbA1C values) set by national quality of care standards reduces diabetes-related complications; however, despite the evidence supporting the importance of these criteria, many patients have measures of diabetes health status that fall outside of these standards. Although 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, there is a lack of effective, sustainable, and scalable strategies to increase patient activation and assist patients in effectively managing their diabetes. The candidate will therefore develop a web-based, diabetes dashboard for patients that illustrates measures of a patient's diabetes health status (e.g., HgbA1C value, diabetic retinopathy screening status) and utilizes established psychological strategies for influencing behavior (i.e., social and goal-based comparisons) and test its ability o increase patient activation and improve the quality for care for patients with diabetes.
| Martinez, William; Threatt, Anthony L; Rosenbloom, S Trent et al. (2018) A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing. JMIR Hum Factors 5:e26 |
| Martinez, William; Wallston, Kenneth A; Schlundt, David G et al. (2018) Patients' perspectives on social and goal-based comparisons regarding their diabetes health status. BMJ Open Diabetes Res Care 6:e000488 |
