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Web Portal
Awards
Outcome Evaluation Awards
Methodology and Design Awards
Web
Portal Awards
Aurora Health Care, Inc.
Principal Investigator: Dr. Alison Lux
Award Amount: 398,851
Weight Management for a Defined Employee Population using
an Interactive eHealth Portal
The proposed research is designed to study the effects of on-line
weight management techniques on health outcomes of employees of
a large urban hospital that is part of an integrated health care
organization serving nearly one-third of the state's population
in eastern and central Wisconsin.
Research aims include determining whether an Internet-based weight
management program including bi-directional communication with
healthcare consultants is cost beneficial as well as effective
at:
- Inducing weight loss beyond that of standard environmental programs
in a hospital employee population.
- Improving secondary outcome measures including insulin resistance,
blood pressures, physical and psychological quality of life, and
serum total and HDL cholesterol.
Beth Israel Deaconess Medical Center
Principal Investigator: Dr. Lisa I. Iezzoni
Award Amount: $399,980
Improving Chronic Disease Care with PatientSite
The team will conduct a randomized, controlled trial of an intervention
to screen 5,000 patients at five adult primary care practices
for the conditions using PatientSite, a Web portal serving more
than 20,000 patients in Eastern Massachusetts. They will send
patients an electronic message via PatientSite one week before
a scheduled primary care office visit with their doctor or nurse
practitioner. The message will screen patients for three chronic
conditions: pain, depression, and difficulty walking and ask them
for informed consent to participate in the study. Patients with
positive screens who consent to participate will be enrolled and
randomized to intervention and control groups. Positive screens
from intervention patients will be forwarded to the clinician
with information about the condition along with diagnostic and
treatment options. Intervention patients, in addition, will receive
automatic electronic feedback and the opportunity to discuss the
problem electronically with a nurse "e-coach."
Geisinger Clinic
Principal Investigator: Dr. Nirav R. Shah
Award Amount: 399,028
Does Access to an EHR Patient Portal Influence Chronic Disease
Outcomes? A Randomized trial assessing Clinical and Behavioral
Change Outcomes in Patients with CHF, Diabetes, or Secondary CVD
Geisinger installed its EHR in 43 primary care outpatient practices
by 2001 and thereafter launched a patient access portal, MyGeisinger.
Dr. Stewart and his team propose to test the hypothesis that use
of a 'push intervention' based on Wagner's Chronic Care Model
among patients with one or more of three important chronic diseases
will result in improved outcomes over a one-year period. Geisinger
Clinic primary care patients who meet inclusion criteria and access
the portal will be randomized to control and intervention groups.
Three categories of outcomes will be evaluated. Among the 4,000
patients they expect to identify, process and clinical measures
will be evaluated using data extracted from the EHR. To evaluate
generalizability, portal users will be compared to a group matched
random sample of non-users on all outcomes.
HispaniCare (Dr. Tango, Inc.)
Principal Investigator: Dr. Dirk Schroeder
Award Amount: $400,000
Evaluation of the MiDieta (MyDiet) eHealth Portal to Facilitate
Improved Diets, Increased Fitness-Levels and Weight-loss among
U.S. Hispanics
More than 300,000 Hispanics access MiDieta, an online diet, fitness
and weight management portal for U.S. Hispanic/Latinos, each week.
MiDieta is bilingual (Spanish/English), based on Latino foods
and habits and is available through media, hospital and health
plan Web sites. The team will conduct a randomized trial to rigorously
test the efficacy of the MiDieta for weight loss among overweight
Hispanics in New Jersey. Primary outcomes are weight-loss and
other anthropometric measures at three, six and 12 months. Secondary
outcomes include diet, physical activity, patient-provider communications
and adherence. Dr. Schroeder and his team will also examine the
modifying effects of language and educational level on outcomes.
Findings will provide sound evidence for whether eHealth portals
are an efficacious means to improving diets, increasing physical
activity levels and promoting healthy weights among Hispanics.
The research will inform future improvements to MiDieta and benefit
the patients and providers that currently access the portal.
The Cleveland Clinic Foundation
Principal Investigator: Dr. C. Martin Harris
Award Amount: 399,830
The Potential of Technology to Improve Chronic Disease Management
and Quality of Care
The team plans to study the extent to which CCF’s diabetic
portal can improve diabetic outcomes and quality of care. Recognizing
that some patients will be more predisposed to adopting technology
and some will be more predisposed to improving their compliance
than others, they will also develop and test interventions that
may improve adoption and compliance. By being able to predict
which patients are most likely to succeed with the portal, it
will be possible to provide additional help to those who are less
likely to adopt. This research will determine if a portal approach
to diabetes management can influence patient outcomes and if additional
interventions can encourage greater technology adoption and patient
compliance. Our use of a widely deployed commercially available
portal will enable broad and rapid dissemination. In addition,
the outcomes from this study can be generalized to other chronic
diseases and health maintenance.
University of Colorado Health Sciences Center
Principal Investigator: Dr. Stephen E. Ross
Award Amount: 397,099
D-STAR (Diabetes-System To Access Records): An Online Patient
Portal to Improve and Sustain Diabetes Self-Care
University of Colorado Hospital developed D-STAR using a behavioral
science model, based on the published experience of the investigators
with an online patient-accessible medical record. D-STAR includes
a chronic disease management program for patients with diabetes,
to improve health by encouraging sustained self-care. It has been
enhanced to engage patients over the long term by displaying personalized
information from the medical record in a patient-friendly format,
and by providing components that can interact with patients in
a dynamic, meaningful manner repeatedly over time. Patients in
the intervention group will receive all components of D-STAR,
while control patients will only receive administrative functions
and bi-directional electronic communication. The primary outcome
measure is change in self-care activities, as measured by the
Summary of Diabetes Self-Care Activities instrument. The team
will also use qualitative techniques to assess the utility of
the program for patients, providers, and staff.
Outcome
Evaluation Awards
HealthMedia, Inc.
Principal Investigator: Dr. Kevin J. Wildenhaus
Award Amount: $496,264
Efficacy of a Web-Based Tailored Weight
Management Program With and Without Tailored Nutrition and Goal
Setting Support
HealthMedia, Inc. and Kaiser Permanente have
undertaken a randomized control of Web-based weight management
programs. Preliminary findings are showing a statistically significant
self-reported weight loss by subjects receiving a tailored behavioral
support program (HealthMedia ® Balance ™) in comparison
with controls receiving standard un-tailored Web-based weight
management information. Building upon the efficacy shown by Balance
™ as a stand alone intervention, this proposed study will
test two enhancements:
- a computer-tailored nutrition program designed
to influence dietary fat, fruit and vegetable and fiber intake;
- a computer-tailored goal setting program
designed to adjust goals based on previous performance, attributions,
self-efficacy and motivation.
The goal of this study is to evaluate the incremental
efficacy of adding or combining these programs with Balance ™
in achieving lasting weight loss over an 18-month time frame.
Secondary analyses will involve the cost-effectiveness and economic
implications of these approaches to mediating behavior change.
The Medstat Group
Principal Investigator: Dr. Tami L. Mark
Award Amount: $496,330
Assessment of a Hand-Held and Internet Information
Technology System to Improve Management of Cancer Related Pain,
Fatigue, and Depression
Dr. Mark and her team will evaluate the effectiveness
of the Supportive Oncology Services (SOS) information system in
reducing the lack of patient information about the efficacy of
treatments and the lack of physician access to real-time symptom
assessments, two key barriers to symptom management. The SOS system
uses pen-based computers (e-tablets) linked via radio frequency
to a dedicated server within an oncology practice. A tested, easy-to-use
software interface on the e-tablet presents the Cancer Care Monitor,
a validated assessment scale for cancer symptoms, that quickly
collects information from patients. Additionally, the computers
deploy the Cancer Support Network, which provides patients with
educational information tailored to their reported symptoms in
text, graphic, video and audio formats via the Internet. New oncology
patients receiving chemotherapy will be randomized to use of the
SOS information system in two large community oncology clinics.
The outcomes will include the proportion of patients assessed
for symptoms, the proportion of patients treated for symptoms,
patient satisfaction with symptom assessment and management, the
level of symptoms and quality of life, cost effectiveness of the
SOS system, patient knowledge and exposure to cancer symptom information.
The Pennsylvania State University
Department of Health Policy & Administration
Principal Investigator: Dr. Kathryn H. Dansky
Award Amount: $475,052
Empowering Elders Through Technology
The study will explore the relationship between
telehomecare and acquisition of knowledge, and will show whether
changes in knowledge levels translate to changes in behaviors
and improved health outcomes. Dr. Dansky’s team will compare
the effects of two different telehomecare systems (nurse-directed
vs. patient-directed) on knowledge, self-management and health
status. They will investigate how the personal characteristics
of older persons influence human-computer interaction and user
satisfaction. A further goal is to illuminate the attitudes of
physicians regarding the use of telehomecare in the treatment
of their elderly, community dwelling patients. This study builds
on current initiatives in telehomecare, undertaken jointly by
Pennsylvania State University and the Pennsylvania Homecare Association
(PHA), a trade association serving home health agencies, hospices
and private duty homecare agencies in Pennsylvania. Results will
inform managers and policymakers who are responsible for integrating
eHealth mechanisms into chronic disease protocols, funding health
care programs and creating policies that support the use of information
technology by all Americans.
University of Massachusetts Medical
School*
Principal Investigator: Dr. Patricia D. Franklin
Award Amount: $472,251
Using Tailored E-mails to Motivate Healthy
Behavior, Improve Health Status, & Reduce Health Care Costs
in Employee Populations: A Randomized Trial
A six-month randomized trial with follow-up
at six and 12 months will evaluate the efficacy of a tailored
e-mail health intervention on employee adoption of healthy behaviors
and secondarily, health outcomes and costs. The intervention uses
evidence-based daily e-mail health tips from an established web
site that also offers self-assessment, personal feedback, tailored
action plans, and self-monitoring tools. Employees at approximately
24-30 work sites will be invited to complete a standard baseline
assessment. One-half of the sites will be randomly designated
as intervention sites and the others as controls. Individuals
at test sites will receive (a) six months of RealAge daily e-mail
health tips presenting evidence-based science as motivational,
action-oriented messages in gain-positive language (intervention)
or (b) monthly health promotion newsletters (control). Participants
will be reassessed at six and 12 months with a standard battery.
Feasibility will be demonstrated by employee participation (i.e.,
emails opened) and satisfaction. Efficacy will be demonstrated
by sustained participation (i.e., use of RealAge Website), an
increase in antecedents of health choices, healthy behaviors and
health status. Cost-effectiveness will be demonstrated by work
productivity lost to illness and health care claims.
* This project was formerly housed at The Research Foundation
of SUNY.
Stanford University
School of Medicine, Patient Education Research Center
Principal Investigator: Dr. Kate R. Lorig
Award Amount: $496,223
Internet Diabetes Self-Management: A Randomized
Trial
This program will be adapted from the online
Chronic Disease Self-Management Program, already developed and
currently being evaluated by the investigators. Participants with
type 2 diabetes will be randomized to participate in the Internet
program or serve as controls continuing with usual care. Treatment
subjects will participate in a structured six-week interactive
Web-based online class with 20-24 other participants and two trained
peer moderators. Data will be collected online at baseline, six
months and one year.
Outcome measures will include:
- health related quality of life (fatigue,
physical discomfort, the symptoms of hypoglycemia and hyperglycemia,
activity limitations, health distress and self-rated health);
- metabolic control (hemoglobin A1c);
- health care utilization (outpatient visits
to physicians, percentage of participants having received an
eye examination in the past year, number of times a health professional
has examined participants' feet and decreases in emergency department
visits, hospitalizations, and hospital days);
- health behaviors (aerobic exercise, communication
with physicians, diet, glucose self-monitoring and self-examination
of the feet);
- self-efficacy to manage diabetes.
University of California San Francisco
School of Nursing, Department of Physiological Nursing
Principal Investigator: Dr. Virginia L. Carrieri-Kohlman
Award Amount: $496,348
Comparing the Effects of an Internet-Based
to an Established Dyspnea Self-Management Program on Dyspnea,
Exercise Behavior and Pulmonary Exacerbations in Patients with
Chronic Obstructive Pulmonary Disease (COPD)
The overall goal of this team is to compare
the impact of an Internet-based dyspnea self-management program
(eDSMP) with a face-to-face program (DSMP) that has been shown
to be effective. The eDSMP, guided by physiological concepts,
social cognitive theory and the transtheoretical model includes
a baseline interview to assess symptoms, exercise history and
prescribe a home based exercise plan; online dyspnea education
via text chats; and use of a mobile device for reporting symptoms
and exercise and providing feedback. Subjects with COPD will be
randomly assigned to the eDSMP or the DSMP. Outcomes will be measured
at baseline, three and six months. Primary outcomes include dyspnea,
exercise behavior and pulmonary exacerbations. Secondary outcomes
are perception of support, self-efficacy for exercise and managing
dyspnea, and health resource utilization. Program usage, satisfaction
and burden will be measured and related to changes in outcomes.
If this eDSMP is as effective as the face-to-face DSMP, it will
represent a first step in establishing an evidence-base for widespread
implementation of self-management programs for people with chronic
illness using the Internet and mobile environments.
The University of North Carolina at
Chapel Hill
Lineberger Comprehensive Cancer Center
Principal Investigator: Dr. Barbara K. Rimer
Award Amount: $495,674
Health eCommunities: The Impact of Listservs
on Cancer Patients
This research group will team with the Association
of Cancer Online Resources (ACOR) to assess the impact of participation
on patients and others (including caregivers) in nine cancer-related
listservs managed by ACOR. In the qualitative phase, they will
conduct a content analysis of a subset of threaded discussions
from archived listserv pages to identify a comprehensive set of
themes and key outcomes. This information will provide a richer
understanding of listserv processes and also will provide checks
and balances on the quantitative survey. They will evaluate the
impact of the ACOR listservs on a range of participant outcomes
by following a cohort of new subscribers for four months. Baseline,
one and four month Web-based and/or telephone surveys will be
administered to consenting subscribers. The team will then disseminate
findings to several key audiences, including listserv moderators
and members as well as to a broader audience.
University of Washington
Department of Medicine
Principal Investigator: Dr. Harold I. Goldberg
Award Amount: $495,414
A Randomized Controlled Trial of Diabetes
Disease Management Over the Internet
This team proposes to conduct a 12-month randomized
controlled trial comparing usual care versus collaborative disease
management over the Internet among disadvantaged African-Americans
with type 2 diabetes. Fifty intervention subjects will be trained
to use an existing diabetes disease management module comprising
six Web sites that are accessed from home via links displayed
within the University of Washington’s "MyUW" Internet
portal. All data can be viewed by patients and providers in online
trended displays that a clinical pharmacist will use to review
cases no less often than weekly. As an attention control, 50 subjects
will also be trained to use a provided personal computer to access
Internet knowledge resources, but will not have access to the
case-management services and module being evaluated. By comparing
the two groups, the aims are to:
- determine the effect of case-managed, Web-based
diabetes care on glycemic control, healthcare utilization, self-efficacy
and patient satisfaction;
- use semi-structured interviews among a purposive
sub-sample of both trial arms to qualitatively identify enablers
of the successful use of computers, the Internet and eHealth
applications by disadvantaged patients.
Methodology
and Design Awards
Baylor College of Medicine
Department of Pediatrics
Principal Investigator: Dr. Debbe Thompson
Award Amount: $98,564
Factors Influencing Log-On Rates in an eHealth
Obesity Prevention Program Promoting Healthy Eating and Physical
Activity to 8-10 Year Old African American Girls
Incentives have been effective at encouraging
youth to engage in desired behaviors, but little is known about
the effect of incentives on youth log-on rates in eHealth programs
or the types of incentives most likely to be effective. This study
will investigate the effect of varying levels of monetary incentives
($0 - $5/wk) on log-on rates in an eight-week obesity prevention
eHealth program for 8-10 year old African American females at
risk of obesity. The results of this study will potentially enhance
the health of youth by increasing their access to valuable health
resources.
Boston Medical Center
Medical Information Systems Unit
Principal Investigator: Dr. Ramesh Farzanfar
Award Amount: $98,640
Development of a Longitudinal Qualitative
Methods Manual and Quantitative Instrument for Evaluating Use
of Multi-Contact eHealth Technologies by Patients and Consumers
This research group will conduct qualitative
sub-studies on users' experience of two computer telephony interventions:
one targeting physical activity promotion in a healthy general
population and the other targeting healthy dietary habits among
hypertensive African-Americans. They will perform a series of
in-depth qualitative interviews and from the results will delineate
the dominant themes of user experience as well as develop an eHealth
Qualitative Research Protocol Manual.
Carnegie Mellon University
Human Computer Interaction Institute
Principal Investigator: Dr. Susan R. Fussell
Award Amount: $77,605
Creation and Evaluation of a Discourse Coding
System to Assess the Benefits of Online Discussion on Mental and
Physical Health
The proposed project adapts Stile's Assimilation
of Problematic Experiences Scale (APES) to self-help chatroom
discourse. The APES was developed to capture how a client’s
speech reflects the degree to which he or she has come to terms
with negative life events. The team’s goal is to develop
and validate a version of the APES that can be used by investigators
to study the impact of participation in online support groups
on mental and physical well-being. Communication-based measures
will allow investigators to evaluate the effects of participation
in Internet support forums without requiring participants to forfeit
their anonymity.
Johns Hopkins Bloomberg School of Public Health
Department of Population and Family Health Sciences
Principal Investigator: Dr. Dina Borzekowski
Award Amount: $98,518
Measuring Exposure to Online Health Messages
Among Adolescents
After completing a survey on demographics, health
behavior and media use, approximately 100 adolescents will perform
a half-hour standard exercise where they turn to the Internet
to seek answers to sexual health questions. During the exercise,
the team will download every page so they know what the adolescents
encountered and use Eye-Movement technology to know exactly where
the adolescents looked on the monitor as they navigated the Web.
At the same time, investigators will collect Clickstream data
such as traversal paths and clicks made by the adolescent. After
the exercise, adolescents will do another survey to assess their
subjective and objective recall of health topics to which they
may or may not have been exposed. The team will then clean, reduce
and summarize the data and analyze if and how Eye-Movement and
Clickstream measures correlate and whether either or both serve
as good predictors of recall.
Kansas University Medical Center
Center for TeleMedicine and TeleHealth
Principal Investigator: Dr. Eve-Lynn Nelson
Award Amount: $95,538
Development of an eHealth Provider-Patient
Communication Measure
This study will modify the Roter Interaction
Analysis System (RIAS), the most widely used interaction analysis
system in the medical setting for coding patient-provider communication,
for use in the interactive televideo (ITV) setting. The RIAS classifies
provider and patient behaviors including instrumental behaviors,
affective behaviors and social conversation. The first phase of
the project will modify the RIAS for the telehealth setting based
on input from a panel of experts. The second phase will assess
the measure in different telehealth clinics in order to develop
a psychometric profile. The third phase will be a re-evaluation
by the panel of experts and teleproviders and the integration
of clinic findings into the final measure development. The proposed
measure will open the door to more thoroughly addressing many
key research questions about communication within telehealth practice,
including comparing telemedicine and face-to-face clinics and
comparing different eHealth technologies.
Stanford University
School of Medicine, Patient Education Research Center
Principal Investigator: Dr. Kate R. Lorig
Award Amount: $50,123
Reliability of Outcome Data Collected via
Internet
Many health status, health care utilization,
behavioral and self-efficacy scales have been tested for both
validity and reliability when mailed to research subjects, but
little is known about the reliability of these instruments when
used for Internet based studies. Thus, the results of Internet-based
studies using self-administered questionnaires are somewhat questionable.
The proposed study will examine the reliability of self-reported
quality of life data, behavioral and health care utilization data
collected via the Internet as compared to mail. In a randomized
study (mail vs. Internet data collection) the following scales
will be tested; self-rated health, illness intrusiveness, fatigue,
shortness of breath, pain, health distress, disability, self-efficacy,
frequency of exercise and use of cognitive techniques, communications
with physicians, utilization of physicians, emergency departments,
hospitalizations and hospital days.
MedStar Research Institute
Principal Investigator: Dr. Susan E. Palsbo
Award Amount: $40,000
Effectiveness Measures for Tele-rehabilitation
To date, there are no randomized controlled
trials of the clinical effectiveness of tele-rehabilitation. Trials
cannot begin until measures validated for outpatient therapy are
validated for tele-rehabilitation. Using Polycom Viewstations,
the team will measure the agreement (Lin's concordance) between
onsite and remote assessments of three speech therapy measures
and two physical therapy measures that are validated with known
psychometric properties for adults with stroke. If the measures
prove to be valid, the team will proceed to a clinical trial next
year.
The University of Texas Health Science
Center at Houston
School of Health Information Sciences
Principal Investigator: Dr. Elmer Victor Bernstam
Award Amount: $98,637
Validation of Quality Criteria for Health
Information on the World Wide Web
Dr. Bernstam and his team hypothesize that an
objective quality-assessment tool can be developed to help consumers
screen out Web sites likely to contain inaccurate health information.
Their specific aims are to identify existing quality criteria
that correlate with health information accuracy. Using breast
cancer Web sites as an example, they will compile a quality-assessment
tool from these criteria and validate the resulting tool in another
domain, complementary and alternative medicine (CAM). They will
then evaluate objective criteria selected from existing quality-rating
criteria with respect to their ability to screen out sites containing
inaccurate statements about breast cancer. For each site, they
will record quality and accuracy of the health information as
judged by a panel of experts. To test the generalizability of
the resulting quality-assessment tool, they will apply it to a
set of Web sites containing information on the most commonly used
CAM treatments.
University of California Los Angeles
School of Medicine
Department of Medicine/Division of Clinical Immunology and Allergy
Principal Investigator: Dr. Adrian Martin Casillas
Award Amount: $98,640
Evaluating the Effectiveness of an eHealth
Application to Improve Chronic Disease Management by Urban, Minority
Children
eHealth applications are limited in their ability
to describe the proficiency of asthmatic children in managing
an asthma episode after using these technology-based educational
interventions. There exists a profound gap in the methodology
for evaluating how these asthma eHealth applications promote behavioral
changes that are necessary to manage asthma. As a result, Dr.
Casillas’ team has designed and implemented a method of
online problem solving using software called IMMEX (Interactive
MultiMedia Exercises) that captures the asthma management strategies
used by asthmatic children. By processing this IMMEX performance
data through artificial neural network analysis, it is possible
to obtain a rich understanding of both individual and group asthma
management skills and strategies.
University of Washington
Department of Health Services
Principal Investigator: Dr. Bryant T. Karras
Award Amount: $98,640
An Evaluation Framework for eHealth Survey
Applications
Currently multiple diverse solutions for implementing
online surveys exist, but there is no generalizable evaluation
methodology available. This team proposes to refine an evaluation
framework and develop an instrument for evaluating online survey
authoring systems and fill this niche.
They will do this by:
- developing an evaluation framework consisting
of a set of qualitative criteria by literature review, expert
opinion and user focus groups to describe characteristics of
Web-based multipurpose systems for authoring patient assessment
and education interventions;
- refining these criteria by having experts
review them and reaching consensus using the Delphi method;
- validate these criteria by applying them
to a set of representative Web-based systems designed for patient
assessment and/or delivery of tailored educational material;
- disseminating both the methodology for characterizing
these systems and the specific assessments of the representative
systems.
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