This Competitive Revision to the current grant (Phase III Trial of Pocket PATH: A Computerized Intervention to Promote Self-Care (NR010711) is being submitted in response to Notice NOT-OD-09-058 supported by the American Recovery and Reinvestment Act of 2009. Lung transplant recipients experience more transplant-related complications, higher health resource utilization and mortality than recipients of other solid organs. Prevention and detection of early complications is known to reduce the likelihood of future impairments in lung function and therefore morbidity and mortality. Despite the scarce donor organs and financial resources expended to support individuals throughout the lung transplant experience, few trials have tested interventions designed to promote self-care behaviors and patient-clinician collaboration with the aim of improving transplant-related health and reducing resource utilization after lung transplant. The purpose of the current trial is to compare the efficacy of a novel intervention, Pocket PATH (Personal Assistant for Tracking Health) for promoting self-care and improving health outcomes relative to standard care after lung transplantation. Pocket PATH provides lung transplant recipients a handheld device with customized data recording, trending and decision-support programs to promote their self-care behaviors. The overall purpose of this competitive revision is to extend the scope of the currently funded PocketPATH project beyond patient behaviors to also support the clinician behaviors known to promote better health outcomes through collaboration and partnership with patients (e.g., support of patient activation, timely data review for evaluation of condition changes and proactive communication). We now propose to design and test a web-based clinician interface (Pocket PATH Link) to support remote data sharing and communication between patients using the Pocket PATH device and their clinician partners. We will then combine the current Pocket PATH features for patients with the new Pocket PATH Link features for clinicians to create a fully integrated application called Pocket PATH Synergy, so that the combination of patients and clinicians working together will lead to health outcomes that are better than the sum of each working separately. Pocket PATH Synergy melds the latest interactive health technologies with the evidence regarding the benefits of patients'being active participants in their care, and the link between patient-clinician collaboration and shared clinical decision making on better health outcomes. The proposal is innovative and well matched to the scientific priorities of NINR-supported competitive revisions including health promotion, disease prevention, self-management and integrating technology into clinical practice. As in the parent grant, while our work is targeted to the needs of lung transplant recipients, it has the potential to inform interventions to promote shared clinician management for individuals living with other chronic illnesses. This competitive revision will allow us to contribute to the aims of the ARRA in the following ways: 1. Stimulate the economy by hiring additional personnel (a usability specialist/human computer interaction specialist and programmer/data base specialist, and trainer/data collector), procuring additional equipment (handheld devices, voice and data service plans, virtual private server, and web-screen capture software), and increasing contracted services (software engineer/programmer). 2. Accelerate the tempo of scientific research by increasing the value of the current project goals and accelerating the rate of evaluation and translation of scientific research. Since completion of the revision period coincides with the final year of the R01, we will have all requisite preliminary work to propose a full-scale translational research study to evaluate the success of Pocket PATH Synergy in promoting shared management of post-transplant health and hence better health outcomes.
The purpose of this revision is to extend the scope of the currently funded Pocket PATH project beyond patient behaviors to also support the clinician behaviors known to promote better health outcomes through collaboration and partnership with patients (e.g., support of patient activation, timely data review for evaluation of condition changes and proactive communication). Although Pocket PATH is being designed and tested with lung transplant recipients, with little modification this intervention has the potential to have a broader impact by promoting self-care behaviors, and thus improving health outcomes, in recipients of other solid organs and in persons with other chronic illnesses. The proposed revision fits well with the goals of the ARRA (NOT -OD-09-058) and the following initiatives and priorities: 1) National Institute of Nursing Research's emphasis on generating and testing new technologies to improve self-management, 2) the NIH Roadmap initiative to build collaborative, interdisciplinary teams to promote health, and 3) the recent Institute of Medicine report to involve patients in the design of health technologies.
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