Medical Informatics Program, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
CDHA Behaviour-Change Institute, QEII Health Sciences Center, Halifax, Nova Scotia, Canada.
Can J Diabetes. 2014 Jun;38(3):205-11. doi: 10.1016/j.jcjd.2014.03.006.
To develop and evaluate Diabetes Web-Centric Information and Support Environment (D-WISE) that offers 1) a computerized decision-support system to assist physicians to A) use the Canadian Diabetes Association clinical practice guidelines (CDA CPGs) to recommend evidence-informed interventions; B) offer a computerized readiness assessment strategy to help physicians administer behaviour-change strategies to help patients adhere to disease self-management programs; and 2) a patient-specific diabetes self-management application, accessible through smart mobile devices, that offers behaviour-change interventions to engage patients in self-management.
The above-mentioned objectives were pursued through a knowledge management approach that involved 1) Translation of paper-based CDA CPGs and behaviour-change models as computerized decision-support tools that will assist physicians to offer evidence-informed and personalized diabetes management and behaviour-change strategies; 2) Engagement of patients in their diabetes care by generating a diabetes self-management program that takes into account their preferences, challenges and needs; 3) Empowering patients to self-manage their condition by providing them with personalized educational and motivational messages through a mobile self-management application. The theoretical foundation of our research is grounded in behaviour-change models and healthcare knowledge management. We used 1) knowledge modelling to computerize the paper-based CDA CPGs and behaviour-change models, in particular, the behaviour-change strategy elements of A) readiness-to-change assessments; B) motivation-enhancement interventions categorized along the lines of patients' being ready, ambivalent or not ready; and C) self-efficacy enhancement. The CDA CPGs and the behaviour-change models are modelled and computerized in terms of A) a diabetes management ontology that serves as the knowledge resource for all the services offered by D-WISE; B) decision support services that use logic-based reasoning algorithms to utilize the knowledge encoded within the diabetes management ontology to assist physicians by recommending patient-specific diabetes-management interventions and behaviour-change strategies; C) a mobile diabetes self-management application to engage and educate diabetes patients to self-manage their condition in a home-based setting while working in concert with their family physicians.
We have been successful in creating and conducting a usability assessment of the physician decision support tool. These results will be published once the patient self- management application has been evaluated.
D-WISE will be evaluated through pilot studies measuring 1) the usability of the e-Health interventions; and 2) the impact of the interventions on patients' behaviour changes and diabetes control.
开发和评估糖尿病网络中心信息和支持环境（D-WISE），该环境提供 1）计算机决策支持系统，以协助医生 A）使用加拿大糖尿病协会临床实践指南（CDA CPGs）来推荐基于证据的干预措施；B）提供计算机化的准备评估策略，以帮助医生实施行为改变策略，帮助患者遵守疾病自我管理计划；2）通过智能移动设备访问的患者特定糖尿病自我管理应用程序，提供行为改变干预措施，使患者参与自我管理。
通过知识管理方法实现上述目标，该方法涉及 1）将基于纸张的 CDA CPGs 和行为改变模型转换为计算机化决策支持工具，以帮助医生提供基于证据的个性化糖尿病管理和行为改变策略；2）通过生成考虑患者偏好、挑战和需求的糖尿病自我管理计划，使患者参与他们的糖尿病护理；3）通过移动自我管理应用程序为患者提供个性化的教育和激励信息，使患者能够自我管理病情。我们研究的理论基础是基于行为改变模型和医疗保健知识管理。我们使用 1）知识建模将基于纸张的 CDA CPGs 和行为改变模型计算机化，特别是行为改变策略的元素 A）改变准备情况的评估；B）根据患者的准备情况、矛盾或未准备好的情况，对动机增强干预措施进行分类；C）自我效能增强。CDA CPGs 和行为改变模型是根据 A）糖尿病管理本体论建模和计算机化的，该本体论是 D-WISE 提供的所有服务的知识资源；B）决策支持服务，使用基于逻辑的推理算法利用糖尿病管理本体论中编码的知识，通过推荐特定于患者的糖尿病管理干预措施和行为改变策略来协助医生；C）移动糖尿病自我管理应用程序，使糖尿病患者能够在家中参与和教育自己管理病情，同时与家庭医生合作。
我们已经成功地创建并对医生决策支持工具进行了可用性评估。一旦对患者自我管理应用程序进行评估，这些结果将发表。
将通过试点研究评估 D-WISE，测量 1）电子健康干预措施的可用性；2）干预措施对患者行为改变和糖尿病控制的影响。
