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Do no digital harm? A multilevel evaluation of technology-facilitated team care on the patient-provider relationship in health disparity populations

Award Number: R01MD018018
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Do no digital harm? A multilevel evaluation of technology-facilitated team care on the patient-provider relationship in health disparity populations - Project Summary: Patient-provider relationships characterized by high levels of commitment and trust are central to delivering high quality care for improved hypertension (HTN)-related outcomes. Unfortunately, health disparity populations are least likely to be in patient-provider relationships characterized by high levels of commitment and trust leading to negative affective, behavioral and physiological patient outcomes including heightened anxiety during the interaction, medication non-adherence, and poor blood pressure (BP) control. COVID-19 not only highlighted these social inequities but also led to a rapid change of our health system – from mainly in-person to telehealth visits. While telehealth has shown great promise in improving the clinical management of HTN, its impact on patient-provider relationships is unclear. Some evidence suggests telehealth could strengthen these relationships through improved access to the care team, but its technical and interpersonal drawbacks may reduce commitment and trust. To address these gaps, this proposal will leverage the infrastructure established by our NIMHD-funded R01, which will support 10 primary care clinics in the integration of technology-facilitated team care (herein called ALTA) to improve medication adherence and BP control in health disparity populations. ALTA enhances standard in-person and telehealth visits with opportunities for patients and providers to interact via secure messaging through the electronic health record (EHR) and patient portals. While a central premise of ALTA is that it will build clinic capacity to deliver equitable, high-quality care to health disparity populations, it was not designed to evaluate the impact of healthcare technologies on patient- provider relationships. Guided by the multilevel NIMHD research framework, the proposed study will employ a mixed methods study design that links four data sources to rigorously evaluate the multilevel impacts of ALTA on relationship commitment (primary outcome), patient-provider trust (secondary outcome) and patient health outcomes (tertiary outcomes) across 10 primary care clinics and 700 patients with uncontrolled HTN (Aims 1 and 2). Our evaluation strategy will combine cognitive, affective and behavioral measures of the patient-provider relationship and patient outcomes to create a multifaceted view of how individual perceptions and actions of the partners change when ALTA is introduced. Specifically, validated self-report measures (e.g., State Anxiety Inventory) will be augmented by automated text analysis of audiotaped interactions and secure messaging using natural language processing techniques, and EHR-extracted data on clinic and home BP readings and medication adherence (i.e., pharmacy records). Aim 3 will explore potential contextual factors (e.g., equity; digital literacy; communication modality) that influence the relationship between ALTA and the interpersonal and patient-level outcomes using self-report and EHR-derived measures. Aim 4 will use the human centered design approach to systematically gather feedback from clinic stakeholders to identify best practices for effective technology-facilitated patient-provider relationships.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $672,560 )
2025	2025	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	003	3	4/17/2025	NON-COMPETING CONTINUATION	$0
2025	2025	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	001	3	4/15/2025	NON-COMPETING CONTINUATION	$672,560
2025	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	000	2	3/4/2025	NON-COMPETING CONTINUATION	$0
2025	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	002	2	4/17/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $672,560

Issue Date FY: 2024 ( Subtotal = $663,302 )
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	000	2	1/29/2024	NON-COMPETING CONTINUATION	$615,436
2024	2024	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	001	2	6/13/2024	NON-COMPETING CONTINUATION	$47,866
														Subtotal = $663,302

Issue Date FY: 2023 ( Subtotal = $707,893 )
2023	2023	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	000	1	7/11/2023	NEW	$707,893
2023	2023	NEW YORK UNIVERSITY	550 1ST AVE	NEW YORK	NY	10016	NEW YORK	USA	Minority Health and Health Disparities Research	001	1	7/26/2023	NEW	$0
														Subtotal = $707,893

Grand Total All Awards = $2,043,755

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Do no digital harm? A multilevel evaluation of technology-facilitated team care on the patient-provider relationship in health disparity populations

Award Number: R01MD018018

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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