Promoting Safety by Engaging Diverse Diabetes Patients and their Caregivers in Secure Messaging - Project Summary/Abstract Dr. Wagahta Semere’s long-term career goal is to be an independent clinician-investigator and leader in developing and implementing technology-based communication interventions to engage caregivers for diverse patients in effective and safe chronic disease care. She has identified engaging caregivers in diabetes management as a critical issue to achieve this goal. This proposal describes her comprehensive 5-year program of training and mentored research. The work proposed is aligned with AHRQ’s Division of Digital Healthcare Research mission to explore how the evolving digital healthcare ecosystem can best advance the quality, safety, and effectiveness of healthcare for patients and their families and addresses several AHRQ Priority Populations (women, elderly, racial/ethnic minorities, low income, and chronic illness groups). While Dr. Semere has a strong background in health services research, this K08 will provide key training in large data analytics, qualitative and mixed methods research, and implementation science. Communication in chronic illness care that leads to shared understanding has been linked to improved adherence, better disease control, and safer outcomes. Patient portals—systems that allow patients convenient access to their health information online and the ability to exchange secure messages (SM) with providers—offer an ideal communication platform to achieve shared understanding and better outcomes in type 2 diabetes (T2D). Caregivers acting as proxies, messaging on patients’ behalf, can enable and expand the ability of patients to engage with providers via SM platforms. Yet, proxies largely remain an untapped resource, especially for racial/ethnic minorities and those with communication barriers, who may benefit most from proxy involvement. The proposed specific aims are (1) to determine the independent effect of patient use of caregiver proxies for secure messaging (SM) on clinical outcomes among T2D patients with and without proxies, (2) to compare the characteristics of SM exchange between T2D patients and their PCPs among patients who do and do not use caregiver proxies, and (3) to develop and test a pilot intervention in the safety-net setting to engage caregivers in SM to promote effective communication and safe disease management for T2D patients. Dr. Semere’s mentorship team is led by Dr. Schillinger and includes nationally recognized health services researchers, communication scientists, qualitative and mixed methods experts, and implementation scientists who together will provide practical guidance to complement her didactic training. In addition, the supportive research environments at UCSF and within the Division of General Internal Medicine at Zuckerberg San Francisco General, will enable her to achieve the proposed project aims. Upon completion of the proposed research and training, Dr. Semere will submit a competitive R-level grant application to test the pilot intervention in a randomized trial across several safety-net clinics. She will possess the skills and experience to make impactful contributions to patient quality and safety in chronic disease through evidence-based and family-centered communication interventions.
