Julie A. Wright, Ph.D. - US grants

DESCRIPTION (provided by applicant): Julie A. Wright, PhD, a behavior change scientist, is applying for a career development (K07) award in cancer prevention, control, behavioral and population sciences to develop the skills necessary to be an independent investigator in the field of behavioral informatics with a concentration in cancer prevention interventions. Her goal is to develop a specialty in designing behavioral informatics interventions which are delivered in primary care and target behaviors related to energy balance, i.e., healthy diet and regular physical activity. Career Development Plan. The career award will enable Dr. Wright to achieve her goals by advancing her expertise in three areas: 1) primary-care based interventions, 2) informatics, and 3) qualitative research methods. The development plan consists of formal course work, annual scientific meetings, and regular mentoring and consultation with a multidisciplinary mentoring team of leading experts in the three target areas. Research plan. Multiple studies have shown that the risk of some cancers can be reduced by consuming a healthy diet, engaging in regular physical activity, and maintaining a healthy body weight. To help reduce the burden of cancer, multi-level, multi-behavior intervention research is needed. Primary care is one level that can be used to educate and empower parents and their children to develop lifelong healthy habits related to energy-balance. The present study will focus on developing a prototype of a computerized office-based system called TIDE (Tailored Informatics for Diet and Exercise) which will assist pediatricians in promoting energy balance behaviors which are aligned with the expert recommendations, e.g. American Academy of Pediatrics. There are three aims: Aim 1 is to do formative research for the development of a computerized system that can improve the patient-physician experience related to counseling on energy balance behaviors;Aim 2 is to develop a prototype of an office-based system, TIDE, which will be integrated into an existing electronic health records system to deliver tailored print material and facilitate brief counseling by the pediatrician;and Aim 3 is to test the feasibility and acceptability of TIDE. The goal of the research plan is to do the formative work which will lead ultimately to the submission of a R01 research proposal in the area of cancer prevention interventions that target energy-balance related behaviors.

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) affects 20 million Americans. CKD can lead to end stage renal disease and is associated with morbidity and mortality at all stages. Early management decreases complications and may ameliorate disease progression, but is often reliant on patient self-care. Research suggests that a large proportion of patients lack fundamental knowledge about kidney disease, its implications, and self-care necessary to attenuate CKD progression to end stages. Patient decision aids are designed to facilitate disease communication, increase patient knowledge, clarify patients' values and engage patients in care. There have been no studies using patient decision aids in pre-dialysis CKD. Moreover, there is a paucity of data available to guide development of CKD patient decision aids for use in practice. The primary goal of this research proposal is to elicit stakeholder (i.e. patient and provider) input on information needs and preferences for developing a CKD decision aid that will 1) support patient-centered CKD communication, 2) facilitate shared learning and decision making between patients and providers, and 3) optimize patient engagement in care. To accomplish this objective, I propose to conduct three inter-related but independent studies. First, I will determine information needs and factors that influence self-care in patients with pre-dialysis CKD using structured interviews and a survey in 250 patients seen in the University of Michigan nephrology outpatient clinics. Second, I will identify physician perspectives about what they need to support patient CKD education and to effectively engage patients in care by conducting structured interviews of fifty physicians (25 primary care, 25 nephrology) who practice in the University of Michigan Ambulatory Clinics. The interviews and survey questions in the first two aims will be grounded on two quality improvement methods namely, cause/effect analysis and quality function deployment. Informed by the first two aims, I will develop and test a patient- centered decision aid, designed to facilitate patient-physician communication and support patient decision making and self-care in pre-dialysis kidney disease. The aid will be tested in a randomized trial with the decision aid the exposure, and intermediate patient modifiable characteristics (knowledge, self-efficacy, and treatment decisional conflict), as co-primary outcomes. The proposed research is likely to improve our understanding about the needs and preferences of key stakeholders involved in CKD communication and care, and provide insight into the effectiveness of patient-centered education interventions on outcomes in pre- dialysis kidney disease.

ABSTRACT Chronic kidney disease (CKD) affects 20 million Americans. CKD can lead to end stage renal disease and is associated with cardiovascular morbidity and mortality. Early management focused on blood pressure control decreases cardiovascular morbidity and mortality and may ameliorate kidney disease progression. Yet, less than 40% of patients with CKD achieve recommended blood pressure targets. There are many barriers to achieving good blood pressure control. One patient-centric barrier we can target is that many CKD patients do not understand the health implications of CKD or what they need to do to optimize their health. Thus, promoting patient behaviors to improve outcomes, including blood pressure control, requires coordinated programs of education and support over time. However, a sustainable, evidence-based model for this does not exist for CKD. The central hypothesis of this study is that early patient CKD education combined with health coach support will improve patient behaviors aligned with blood pressure control by increasing patient knowledge, self-efficacy, and motivation. These in turn will lead to optimal health behaviors and improved blood pressure control. The long-term goal of this research is to develop, test, and disseminate sustainable patient-centric education and coaching support interventions to improve quality and outcomes in CKD. The objective of this proposal is to test the impact of a pilot-tested, provider-delivered patient education tool, followed with health coaching focused on blood pressure control. A cluster-randomized controlled trial will compare outcomes in patients with CKD stages 3-5 between intervention and control groups in primary care settings. Continuous quality improvement and systems methodologies will be used to optimize resource neutrality and identify how to leverage existing technology and resources to support implementation and future dissemination. Involving local partners from a state-wide primary care practice-based research network will support future transferability and uptake into community settings. This research is innovative because it represents a new and substantially different approach to addressing an important public health problem by focusing early in the care continuum to educate patients about CKD and supporting them in achieving clinical health targets by giving them coach support. Continuous quality improvement and systems methodologies will reinforce efficiency in the process, which is critical to future uptake in real-world practice. The proposed research is significant as it will result in a rigorously- tested, provider-delivered patient education tool and an efficient process for follow up that supports patients early in the care continuum. The end result will be a streamlined and efficient intervention that is well-poised for dissemination into community practice settings.