ACADEMIC EDGE INC
There has been significant improvement in our understanding and articulation of ideal patient and provider diabetes management practices. However, these optimal diabetes care behaviors are often not achieved in real world clinical experiences as a result of environmental and psychosocial barriers faced by providers and by patients. A significant barrier both to optimal provider practice and to optimal patient self-management and regimen adherence is "face time"-the amount of time available to the patient and provider to engage in any given clinical encounter. In particular, extreme time pressures placed upon PCP and the common lack of support structures, often cause the focus of the diabetic PPI to shift away from important but time-intensive elements of self- management, such as lifestyle change and behavioral modification support, toward a more narrow emphasis on "fixing the numbers," with, perhaps as a result, the vast majority of patients not being treated to target. For patients, infrequent and erratic contact with the health care system may lead to suboptimal diabetes self- management as a result of relatively inconsistent opportunities for feedback regarding and reinforcement of their medication regimen, and their lifestyle change and behavioral modification efforts. Ideally, this situation would be remedied by providing PCPs with more time for diabetic PPIs; however, for a variety of sociotechnical reasons this is unlikely to occur within the structure and pressures of the US healthcare system. Therefore, other approaches to achieving more optimal outcomes, without increasing provider and patient burden, must be explored. One innovative approach to increasing the frequency and duration of the PPI is to extend such "face time" with web-based, interactive technologies, including social virtual reality environments (SVRE). Such an extension of the clinical encounter would represent a valuable augmentation of usual care, increasing opportunities for patient outcome tracking, feedback, and reinforcement, and thereby potentially improving adherence, reducing mismanagement and sequalae, and improving patient outcomes and quality of life. The effort will examine the impact of using SVRE and other technologies to augment usual care. The effort will integrate technology between PPIs as well as translate aspects of ideal PCP diabetes management care to a SVRE by carefully creating a PCP diabetes care SVRE through an established iterative user-centered development methodology. The acceptability, utility, and impact of the resulting SVRE will be examined in a controlled, mixed methods, multivariate, repeated measures field trial with follow-up conducted among diabetes patients and providers within the IUSOM medical care system.