Self-Management Using Text Messaging in a Homeless Population
Improving Self-Management of Chronic Conditions Among Homeless Persons: a Community-Based Participatory Approach Using Text Messaging
調査の概要
詳細な説明
Boston Healthcare for the Homeless Program (BHCHP) is the study site for this research. It is the largest freestanding health care for the homeless program in the country - it provides primary care, behavioral health, oral health care and other wrap-around services to 12,500 homeless individuals a year. BHCHP was recently awarded a two-year grant from the Massachusetts Health Policy Commission to demonstrate how intensive, coordinated case management can reduce costs of caring for homeless persons who are high utilizers of emergency department (ED) and inpatient care. The Social Determinants of Health Coordinated Care Hub for Homeless Adults project (hereafter the "Care Hub") will create capacity among 9 Boston organizations serving homeless residents to meet their needs in primary care, behavioral health, housing, and shelter. This will improve quality of life, health outcomes, and care efficiency for the organizations. The participating organizations, in addition to BHCHP, are Bay Cove Human Services, Boston Public Health Commission, Boston Rescue Mission, Casa Esperanza, Massachusetts Housing and Shelter Alliance, The New England Center and Home for Veterans, St. Francis House, Victory Programs Specifically the investigators anticipate that patients participating in the Care Hub will have reduced use of ED and inpatient care because they will be better linked to and retained in appropriate care such as outpatient, mental health, substance use disorder (SUD), preventive care, and respite care. Regular care will increase the appropriate management of chronic health conditions and reduce episodes of exacerbations of these conditions which often lead to ED and hospital care. The purpose of this study is to evaluate whether an a text messaging system of appointment reminders, along with medication taking messages, and text messages about mood will augment the effectiveness of the Care Hub program.
The investigators propose to pilot a cell phone-based outpatient care support and medication reminder system. The content will include appointment reminders and educational and motivational messages about the importance of going to all outpatient care visits and of taking medications. The investigators take a community-based participatory research approach to this study - both because it appropriately considers the needs of the target population (increasing the likelihood of success) and because it empowers a population that is often treated as if its members were powerless. The cell phone texting intervention will help patients stay engaged in care, adhere to their medications, and adopt and sustain behavior change. This will be accomplished by completing a series of objectives:
- To develop a text messaging system designed for homeless patients which includes appointment reminders, medication taking reminders and motivation, and texts messages that allow participants to report their mood, all in support of chronic disease management. The system will be based on a health coaching model, and message content will be reviewed and edited by patients who are members of drafted by patient members of a BHCHP Community Innovation Panel (CIP).
- To train Care Hub intervention patients (or refresh existing skills) in cell phone text messaging.
- To test the text messaging system in a randomized pilot study with 60 patients, comparing outpatient, respite care, ED, and inpatient utilization, and Health-Related Quality of Care (HRQOL) between the 30 intervention and 30 control patients.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Massachusetts
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Boston、Massachusetts、アメリカ、02118
- Boston University School of Public Health
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- is a patient participant in the Coordinated Care Hub Initiative
- is willing to receive text messages
- is able to understand English - spoken and read
Exclusion Criteria:
- has an inability to find, open, and respond to a test text message
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:Text Messaging
This group will receive text messages with appointment reminders, medication taking education and motivation, and for reporting of mood.
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Subjects will receive text messages with reminders of their upcoming outpatient health care appointments at the Boston Health Care for the Homeless Program (BHCHP) clinic.
The text message will indicate the time of the appointment and the location (e.g.
"Remember appointment Friday March 15 at 10am in the Yawkey building").
Appointment reminder text messages will be sent 3 days ahead and again 1 day ahead of the appointment date.
Medication related texts will be sent every other day and will be educational and motivational (e.g.
"Keep taking medications that way the doctor prescribed them, even if feeling fine").
Mood related texts will also be sent every other day and ask about mood on a 1 to 5 scale.
The participant will text back a response.
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プラセボコンパレーター:Control
This group will receive simple text messages about general health promotion, such as about the importance of drinking water on hot days, using sunscreen, etc.
|
Subjects will receive text messages with reminders of their upcoming outpatient health care appointments at the Boston Health Care for the Homeless Program (BHCHP) clinic.
The text message will indicate the time of the appointment and the location (e.g.
"Remember appointment Friday March 15 at 10am in the Yawkey building").
Appointment reminder text messages will be sent 3 days ahead and again 1 day ahead of the appointment date.
Medication related texts will be sent every other day and will be educational and motivational (e.g.
"Keep taking medications that way the doctor prescribed them, even if feeling fine").
Mood related texts will also be sent every other day and ask about mood on a 1 to 5 scale.
The participant will text back a response.
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Emergency Department Visits Made
時間枠:4 months
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Data from BHCHP's electronic medical record (EMR) and from the Coordinated Care Hub electronic case management system in use by the Care Hub organizations, which includes admission and discharge data
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4 months
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Inpatient admissions
時間枠:4 months
|
Similar to Emergency Department visit data, this will come from BHCHP's EMR and from the electronic case management system
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4 months
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Appointment keeping
時間枠:4 months
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Ratio of kept appointments to all appointments scheduled, based on the BHCHP EMR (e.g.
0-100%).
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4 months
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Medication Adherence
時間枠:4 months
|
Self report medication adherence is assessed with 2 measures: Morisky adherence scale, (range, 0=poor to 11=excellent) and a 1-item rating question in which patients rate their ability to take all their medications as prescribed (range, 1=very poor to 6=excellent)
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4 months
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Adult Well-Being Assessment
時間枠:4 months
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This 9-item health-related quality of life (HRQOL) assessment is a validated measure developed by the Institute for Healthcare Improvement.
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4 months
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Comfort with Computers and Cell Phones
時間枠:4 months
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The eHealth Literacy Scale, eHEALS, (range 8-40, higher equals greater self-efficacy) assesses comfort with computers and the Internet for health related purposes.
Investigators will also adapt eHEALS so that separate items can be asked about comfort with cell phone use.
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4 months
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Frequency of Cell Phone Use and Computer Use
時間枠:4 months
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Measures come from the Health Information National Trends Survey (HINTS).
Scale ranges from 0 (no use) to 12 (frequent use of many features).
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4 months
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Outpatient appointments
時間枠:4 months
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Number of outpatient visits made
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4 months
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Donald K McInnes, ScD、Boston University and Department of Veterans Affairs
出版物と役立つリンク
一般刊行物
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研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- H-35967
- catalyst grant (その他の識別子:BU SPH)
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