SBIR Phase I: eLearning system that enables patient-centered, team-based care and reduces physician shortages in medically underserved areas

这项小企业创新研究（SBIR）第一阶段项目的广泛影响/商业潜力是，通过开发一种工具，分析联邦合格医疗中心（fqhc）的临床护理团队绩效数据，为员工自动部署量身定制的电子学习支持，从而实现以患者为中心的团队护理，显著减少美国初级保健医生短缺，提高低收入患者的护理质量。fqhc由美国卫生与公众服务部资助，为生活在全国一万多个最贫困社区的2200万低收入患者提供服务。实施良好的以患者为中心的以团队为基础的护理有可能显著减少医生短缺和慢性疾病的负担，而慢性疾病对低收入社区的影响尤为严重。然而，推动和维持FQHCs参与这一模式的努力取得了有限的成功，2016年只有66%的FQHCs获得了以患者为中心的医疗之家（PCMH）的认可。各种公共倡议，包括卫生资源和服务管理质量改进奖和医疗保险获取和CHIP再授权法案（MACRA），正在提供额外的财政激励措施，以推动初级保健实践向PCMH认可。然而，目前的实践转化方法是繁琐的，难以维持。拟议的项目旨在通过评估开发一种工具的可行性，破坏fqhc的继续卫生专业教育，该工具利用电子健康记录数据来识别以患者为中心的糖尿病患者团队护理的差距，并根据护理团队的每个成员的表现，为他们部署量身定制的异步个性化电子学习推动式支持。SBIR第一阶段的研究目标是建立通过API使用电子病历数据的可行性，以触发个人用户和团队级别的标志，以确定特定PCMH标准和糖尿病临床协议的差异；开发生成个性化学习者用户档案和团队级报告的算法；生成数据以设计从用户偏好、对标志的影响和患者结果中学习的算法；设计用户界面以获得奖励和认可，并评估最终用户对电子学习工具的接受程度。这项研究将采用以用户为中心的设计、行为经济学和成人学习原则来收集具体需求，并针对5到10个指标的子集开发最小可行产品。

The broader impact/commercial potential of this Small Business Innovation Research (SBIR) Phase I project is to significantly reduce primary care physician shortages and improve quality of care for low income patients in the United States by developing a tool that analyzes clinical care team performance data at federally qualified health centers (FQHCs) to automatically deploy individually tailored eLearning support for staff members that enables patient centered team based care. FQHCs are funded by the U.S. Department of Health and Human Services to serve 22 million low income patients living in more than 10,000 of the poorest communities across the Nation. Well-implemented patient centered team-based care has the potential to significantly reduce physician shortages and burden of chronic disease which disproportionately affects low income communities. However, efforts to move and sustain FQHCs participation in this model have had limited success with only 66% attaining patient centered medical home (PCMH) recognition in 2016. Various public initiatives, including the Health Resources and Service Administration Quality Improvement Award and Medicare Access and CHIP Reauthorization Act (MACRA), are providing additional financial incentives to move primary care practices towards PCMH Recognition. However, current approaches to practice transformation are cumbersome and difficult to sustain.The proposed project seeks to disrupt continued health professional education at FQHCs by assessing the feasibility of developing a tool that leverages electronic health record data to identify gaps in patient centered team based care for diabetic patients and deploys tailored asynchronous individualized e-learning nudge type support to each member of the care team based on their performance. The research objectives of this SBIR Phase 1 are to establish the feasibility of using EHR data through an API to trigger individual user and team level flags for variation from a specific set of PCMH standards and diabetes clinical protocols; to develop algorithms that generate an individualized learner user profile and teams level reports; to generate data to design algorithms that learn from user preferences, impacts on flags and patient outcomes; to design user interphase for reward and recognition and to evaluate end user acceptance of eLearning tools. The research will be approached using user centric design, behavioral economics and adult learning principles to gather specific requirements and develop a minimum viable product focused on a subset of between five to 10 indicators.