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CDA 09-016 – HSR&D Study

 
CDA 09-016
Understanding Health Information and Informatics Needs of Veterans
Donald K McInnes ScD MS BA
VA Bedford HealthCare System, Bedford, MA
Bedford, MA
Funding Period: February 2010 - January 2015

BACKGROUND/RATIONALE:
Consumer health informatics such as electronic personal health record (PHR) systems, mobile devices, and the internet, give patients online access to health information and their medical record, and enable transactions such as ordering medication refills. Little is known about how veterans with serious chronic conditions are using the VAs PHR (called My HealtheVet or "MHV") and other health informatics technologies, or whether the use of such systems facilitates chronic disease self-management.

OBJECTIVE(S):
1) Understand the factors associated with Internet and MHV use among veterans, and assess the extent to which such use contributes to HIV-self-management. We will:
a)Assess the association of demographics, health-related attitudes and beliefs, HIV sero-status, and health status with veterans' use of the internet and My HealtheVet for health-related purposes (e.g. gathering information, ordering prescription refills).
b)Assess whether health-related use of the Internet and MHV is associated with patients' HIV self-management, e.g. patient activation, self-efficacy for communication with providers, and adherence to medication and care visits.
2) Explore patient perceptions of internet and MHV use for health-related purposes.
3) Develop and pilot test a prototype care communication intervention to assist HIV+ veterans with disease self-management. A prominent feature of the intervention involves patients sharing their MHV record with an informal caregiver.
4) Prepare a randomized controlled trial of the care communication intervention.

METHODS:
Objective #1: we are conducting a secondary analysis of longitudinal data (n=approximately 6,000 veterans) from an ongoing observational cohort study, the Veterans Aging Cohort Study (VACS). We will use univariate, bivariate, and multi-variate analytical techniques to characterize differences between veterans who use and do not use internet and MHV (objective #1a). We will use multi-variable regression to assess whether internet and MHV use has an independent association with self-efficacy for self-management and adherence to anti-retroviral therapy (using pharmacy refill data and self-report) (objective #1b);

Objective #2: we will use focus groups and semi-structured interviews to evaluate patient and informal caregiver preferences, barriers, and facilitators related to health informatics tools to improve disease self-management. Analysis will use modified grounded theory.

Objective #3: we will develop and pilot test a communication intervention that uses consumer health informatics such as MHV or mobile devices to improve communication between Veterans and their clinicians and/or their informal caregivers. We will use participatory design (i.e. frequent input from Veterans) at different stages of the development.

Objective #4: We will randomize participants to either the intervention plus usual care, or an information brochure plus usual care. We will use self-report and CPRS data to assess self-efficacy for self-management, medication adherence, and retention in care.

FINDINGS/RESULTS:
None at this time

IMPACT:
This project resulted in improved tools and mechanisms for Veterans to engage in the VA health care system and to improve their ability to self-manage chronic health conditions (e.g. treatment adherence, healthy behaviors, retention in VA health care). This improved engagement and continuity of care leads to more appropriate use of health care services (e.g. increases in outpatient care and decreases in emergency department use and inpatient stays). These impacts are designed to target vulnerable groups who in the past were affected by the digital divide, i.e. they were less likely, compared to the general population, to access and use information technologies for health related purposes. Lessons from our text messaging system with vulnerable veterans have been applied to the development of national text messaging services organized by the VA's Office of Connected Health. That system, called "Annie", is in beta-testing in 3 VA hospitals.


External Links for this Project

Dimensions for VA

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PUBLICATIONS:

Journal Articles

  1. LaCoursiere Zucchero T, McDannold S, McInnes DK. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. BMC health services research. 2016 Sep 7; 16:480. [view]
  2. Ohl ME, Perencevich E, McInnes DK, Kim N, Rimland D, Akgun K, Fiellin DA, Skanderson M, Wang K, Justice A. Antiretroviral adherence among rural compared to urban veterans with HIV infection in the United States. AIDS and behavior. 2013 Jan 1; 17(1):174-80. [view]
  3. McInnes DK, Brown JA, Hays RD, Gallagher P, Ralston JD, Hugh M, Kanter M, Serrato CA, Cosenza C, Halamka J, Ding L, Cleary PD. Development and evaluation of CAHPS questions to assess the impact of health information technology on patient experiences with ambulatory care. Medical care. 2012 Nov 1; 50 Suppl:S11-9. [view]
  4. McInnes DK, Hardy H, Goetz MB, Skolnik PR, Brewster AL, Hofmann RH, Gifford AL. Development and field testing of an HIV medication touch screen computer patient adherence tool with telephone-based, targeted adherence counseling. Journal of the International Association of Providers of AIDS Care. 2013 Nov 1; 12(6):397-406. [view]
  5. Fix GM, Hogan TP, Amante DJ, McInnes DK, Nazi KM, Simon SR. Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives. Journal of medical Internet research. 2016 Nov 22; 18(11):e308. [view]
  6. Chinman M, McInnes DK, Eisen S, Ellison M, Farkas M, Armstrong M, Resnick SG. Establishing a Research Agenda for Understanding the Role and Impact of Mental Health Peer Specialists. Psychiatric services (Washington, D.C.). 2017 Sep 1; 68(9):955-957. [view]
  7. Miller CJ, McInnes DK, Stolzmann K, Bauer MS. Interest in Use of Technology for Healthcare Among Veterans Receiving Treatment for Mental Health. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2016 Oct 1; 22(10):847-854. [view]
  8. Khan MR, McGinnis KA, Grov C, Scheidell JD, Hawks L, Edelman EJ, Fiellin DA, McInnes DK, Braithwaite RS, Justice AC, Wang EA. Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US. AIDS Care. 2019 Mar 1; 31(3):349-356. [view]
  9. McInnes DK, Shimada SL, Midboe AM, Nazi KM, Zhao S, Wu J, Garvey CM, Houston TK. Patient Use of Electronic Prescription Refill and Secure Messaging and Its Association With Undetectable HIV Viral Load: A Retrospective Cohort Study. Journal of medical Internet research. 2017 Feb 15; 19(2):e34. [view]
  10. McInnes DK, Petrakis BA, Gifford AL, Rao SR, Houston TK, Asch SM, O'Toole TP. Retaining homeless veterans in outpatient care: a pilot study of mobile phone text message appointment reminders. American journal of public health. 2014 Sep 1; 104 Suppl 4:S588-94. [view]
  11. Turvey CL, Zulman DM, Nazi KM, Wakefield BJ, Woods SS, Hogan TP, Weaver FM, McInnes K. Transfer of information from personal health records: a survey of veterans using My HealtheVet. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2012 Mar 1; 18(2):109-14. [view]
  12. McInnes DK, Solomon JL, Bokhour BG, Asch SM, Ross D, Nazi KM, Gifford AL. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives. BMC research notes. 2011 Aug 15; 4:295. [view]
Reports

  1. Dyer EA, Kansagara D, McInnes DK, Freeman M, Woods S. Mobile Applications and Internet-based Approaches for Supporting Non-professional Caregivers: A Systematic Review. Washington (DC): Department of Veterans Affairs; 2012 Nov 1. 1-61 p. Report No.: VA-ESP Project #05-225. [view]
VA Cyberseminars

  1. McInnes DK. Internet and My HealtheVet Use for Chronic Disease Self-Management. [Cyberseminar]. 2010 Dec 7. [view]
Conference Presentations

  1. McInnes DK, Hardy H, Goetz M, Skolnik P, Brewster A, Hofmann R, Gifford AL. Development and Testing of a Touch-Screen Patient Adherence Tool with Targeted Adherence Counseling. Paper presented at: VA HSR&D National Meeting; 2011 Feb 18; National Harbor, MD. [view]
  2. McInnes DK, Fix GM, Solomon J, Shimada SL, Gifford AL, Houston TK. Feasibility of Mobile Phone Technologies to Engage Homeless Persons in Outpatient Care. Poster session presented at: American Medical Informatics Association Annual Symposium; 2013 Nov 16; Washington, DC. [view]
  3. Turvey CL, Shimada S, McInnes K, Woods SS, Simon SR, Nazi K. Increasing Veteran Adoption of My HealtheVet: Collaboration between the eHealth QUERI and Operational, Clinical, and Community-based Partners. Presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD. [view]
  4. McInnes DK, Solomon J, Shimada SL, Bokhour BG, Houston TK, Gifford AL, Asch SM, Samore MH. Intervention to Provide Internet and Personal Health Record (PHR) Skills to Persons with Serious Chronic Conditions. Poster session presented at: American Medical Informatics Association Annual Symposium; 2010 Nov 15; Washington, DC. [view]
  5. Fix GM, Eagan A, Etchin A, Findley K, Gifford AL, McDannold S, Reisinger D, McInnes K. Nurses and nursing assistants' perceptions of respiratory protective equipment: a qualitative analysis of moments of risks. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 20; Boston, MA. [view]
  6. McInnes DK. Patient Reports about Health IT: Developing and Field Testing Survey Questions for Outpatient Settings. Paper presented at: Agency for Healthcare Research and Quality Annual Conference; 2011 Sep 20; Bethesda, MD. [view]
  7. Hill JN, Hogan TP, Bauer ED, Smith BM, Stroupe KT, Gordon HS, McInnes DK, Weaver FM. Personal Health Information Management and Source Preferences in Persons Managing Multiple Co-Morbid Chronic Conditions. Paper presented at: American Academy on Communication in Healthcare International Conference on Communication in Healthcare; 2012 Oct 12; Providence, RI. [view]
  8. McInnes DK, Shimada SL, Rao S, Quill A, Duggal M, Gifford AL, Brandt CA, Houston TK, Ohl ME, Gordon KS, Mattocks KM, Arar NH. Personal Health Record (PHR) Use and Its Association with Medication Adherence. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2012 Jul 18; National Harbor, MD. [view]
  9. McInnes DK, Solomon J, Shimada SL, Bokhour BG, Houston TK, Nazi KM, Petrakis BA, Gifford AL, Asch SM. Teaching Veterans to Use the Internet and My HealtheVet for Self-Management of Serious Chronic Conditions. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 18; National Harbor, MD. [view]
  10. McInnes DK. Using Internet and My HealtheVet Personal Health Record to Improve Self-Management of Chronic Conditions. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 25; San Francisco, CA. [view]


DRA: Infectious Diseases, Health Systems
DRE: Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: none
MeSH Terms: none

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