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

> **NIH NIH R01** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $663,302

## Abstract

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 an...

## Key facts

- **NIH application ID:** 10885918
- **Project number:** 5R01MD018018-02
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Antoinette M Schoenthaler
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $663,302
- **Award type:** 5
- **Project period:** 2023-07-11 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10885918

## Citation

> US National Institutes of Health, RePORTER application 10885918, Do no digital harm? A multilevel evaluation of technology-facilitated team care on the patient-provider relationship in health disparity populations (5R01MD018018-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10885918. Licensed CC0.

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