Burnout, Professional, Implicit Bias, Motivational Interviewing, Multiple Chronic Conditions, Patient Engagement
Conditions
Keywords
Motivational Interviewing, Artificial Intelligence, Multiple Chronic Conditions, Clinician Wellbeing, Biases, Patient Engagement
Brief summary
This study will examine the impact of training primary care providers (PCPs) in motivational interviewing (MI) using artificial intelligence (AI) to augment the training process. MI is a patient-centered approach to engaging patients in their own care. There will be a control group and two intervention groups, with the intervention groups receiving a different amount of MI training. The hypothesis is that the AI-augmented MI training will result in improved patient outcomes, improved clinician wellbeing, and reduced behavioral manifestation of clinician biases. This mixed-methods project will also collect qualitative data from structured interviews and focus groups with participating PCPs to examine perceived facilitators and barriers to the use of the MI approach in primary care.
Detailed description
Motivational interviewing (MI) is an evidence-based patient-centered approach that has been demonstrated to be effective in increasing patient engagement in their own care. Using MI, a clinician is compassionate curious to understand patients' perspective on their behavior, and conversationally guides them to discover a need for behavior change. However, MI is not widely utilized in primary care practices and challenging to teach, in part because many primary care providers (PCPs) take a direct approach with their patients by educating and advising them regarding steps to improve their health. However, simply telling patient what to do tends to be ineffective, leading to frustration on the part of both patients and PCPs. To help implement the MI approach more widely, our team has developed an artificial intelligence (AI) augmented tool for MI skill development, ReadMI™ (Real-time Assessment of Dialogue in Motivational Interviewing). The goal of this project is to: 1) examine the association of AI-measured proficiency in MI to patient outcomes, PCP wellbeing, and PCP manifestations of bias, and 2) to determine the extent to which AI-augmented MI skills training can impact the same outcome, wellbeing, and bias manifestation variables in a randomized controlled trial (RCT). This mixed-methods project will also employ structured interviews and focus groups of participating PCPs to collect qualitative data for better understanding both facilitators and barriers to the implementation of MI in primary care. The overall hypothesis is that PCPs with the strongest MI proficiencies will have patients with better outcomes, and that those PCPs will also demonstrate less burnout and less manifestation of bias. Additionally, it is hypothesized that making use of AI in MI training will be seen by PCPs as a facilitator to the use of MI in their practices.
Interventions
BEHAVIORALBasic AI (artificial intelligence)-Augmented Motivational Interviewing Training
Basic participants will participate in two motivational interviewing (MI) training sessions that involve role-play practice of MI. Artificial intelligence (AI) will be used to provide metrics on MI-skills (percentage of the time the clinician talks, use of open-ended questions, use of closed-ended questions, use of reflective statements, use of 0-10 scales) as measured by the ReadMI™ tool (Real-time Evaluation of Dialogue in Motivational Interviewing), and both the spirit of MI and presence of bias as measured by Dougall GPT.
BEHAVIORALPlus AI (artificial intelligence)-Augmented Motivational Interviewing Training
Plus participants will participate in four motivational interviewing (MI) training sessions that involve role-play practice of MI. Artificial intelligence (AI) will be used to provide metrics on MI-skills (percentage of the time the clinician talks, use of open-ended questions, use of closed-ended questions, use of reflective statements, use of 0-10 scales) as measured by the ReadMI™ tool, and both the spirit of MI and presence of bias as measured by Dougall GPT.
Sponsors
Premier Health
Wright State University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Primary care provider (PCP) participants will be randomly assigned to intervention (IG) or control (CG) groups, with the Basic IG receiving two ReadMI (Real-time Evaluation of Dialogue in Motivational Interviewing)-supported motivational interviewing (MI) trainings and the Plus IG receiving four MI trainings. Plus will receive two MI trainings at the same time as Basic and will receive two additional MI trainings one year later.
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Primary care providers (physicians, physician assistants, and nurse practitioners) employed in primary care practices of the Premier Physician Network of Premier Health (southwest Ohio) are eligible to participate.
Exclusion criteria
* Eligible PCPs who opt to not provide informed consent for participation will be excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MI Communication Metrics | Months 4-7, Months 16-20, Months 30-33 | Motivational interviewing skills/metrics (percentage of time the clinician speaks, number of open-ended questions, number of close-ended questions, number of reflective statements, number of 0-10 scales). Each of the metrics is the total number of occurrences. |
| MI Spirit | Months 4-7, Months 16-20, Months 30-33 | Using a 0-10 scale, the spirit of motivational interviewing (MI) in a role play with a standardized patient will be measured by two artificial intelligence (AI) tools respectively: ReadMI and Dougall GPT. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Aggregated Patient Data for Each Participating PCP | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | Data routinely collected by the Premier Physician Network for participating primary care providers (PCPs). All measures are percentages of patients 0% - 100%) indicating that their PCP listened, explained things clearly, and would recommend the PCP). Also, percentages of patients (0%-100%) of patients with poor hemoglobin A1c control, with hypertension control, and completing recommended screenings for each participating PCP are provided. |
| Perceived Stress Scale (PSS) | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | Scale with 10 items (4 pt Likert scale) measuring perceived experience of stress. Scores range from 0-40 with 0 being the least amount of stress. |
| Brief Resilience Scale (BRS) | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | Six-item scale (5 pt Likert scale) assessing responses to stressful periods. Scores range from 6-30 with higher scores indicating more resilience. |
| Bias Manifestation | Months 4-7, Months 16-20, Months 30-33 | Dougall GPT will be used to identify the number of biases evident in a role play with a standardized patient. |
| Stress Mindset Measure (SMM) | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | This 8-item (5 pt Likert scale ranging from 0=strongly disagree to 4=strongly agree) measures perspectives on stress as debilitating versus enhancing. Scores range from 0 to 32 with higher scores indicating a mindset that stress is enhancing. |
| MI Survey Measure | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | Three items (5 pt Likert scale) assess PCP (primary care provider) attitudes regarding the impact of motivational interviewing (MI) training on confidence, intent to use/incorporation of the MI approach, and importance of MI training for other PCPs. Scores range from 3 to 15 with higher scores indicating more positive regard for MI. |
| Diversity Awareness Self-Reflection Tool (DASRT) | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | SeventeenValues and Attitudes items (three response alternatives for each item ranging from 1=things I do often to 3=things I do rarely) from the Diversity Awareness Self-Reflection Tool will be used to assess PCP (primary care provider) self-awareness of their attitudes and behavior toward patient of diverse backgrounds. Scores range from 17 to 51 with lower scores indicating a higher degree of diversity competency. |
| Clinician Support for Patient Activation Measure (CS-PAM) | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | This 13-item scale (response options range from 1 = not important to 4 = extremely important) assesses PCP (primary care provider) attitudes and self-reported behaviors related the patient engagement in the management of their health conditions. Scores are translated into a 1-100 scale (Rasch methods) with higher scores indicating more positive beliefs about patients' invovlement in their care. |
| Mini Z (Zero) Burnout Scale 2.0 | Months 4-5, Months 16-17, Months 25-26, Months 32-33 | Ten survey questions (5 pt Likert scale) assessing perceived burnout and factors contributing to burnout. Scores range from 10-50, with 10 indicating the least amount of burnout. |
Countries
United States
Contacts
Primary ContactPaul J Hershberger, PhD
Backup ContactMary Crane, MBA
Outcome results
None listed