Pulmonary Specialist-Health Coach Consult (PuSHCon) model to improve access to specialist consultation and receipt of recommended evidence-based care for vulnerable patients with COPD and asthma

项目总结/摘要 拟进行的平行组、随机分组对照试验将评估 肺科专家-健康教练（PuSHCon）在获得专家方面的新模式 慢性阻塞性肺疾病患者的循证护理 肺疾病（COPD）和/或哮喘，在联邦合格的健康中心（CDC）接受治疗。 PuSHCon模型是在患者、研究者、初级保健 临床医生、专家和旧金山弗朗西斯科医疗保健网络内的卫生保健中心在随机化 健康指导对中重度COPD患者的对照试验。在PuSHCon模型中， 经过培训的非专业（无执照）卫生工作者在患者自己的诊所与患者会面 收集肺科专家进行评估所需的广泛信息， COPD和/或哮喘的循证护理建议。健康教练随后与 医院的肺科专家可以评估患者， 建议，而不需要病人看到。这些建议已传达 患者的初级保健提供者（PCP）。健康教练与PCP沟通 并与患者会面以解释建议并支持其实施。 拟议的研究将在旧金山弗朗西斯科健康网络的10个诊所进行， 共享电子病历和单一电子转诊流程（eReferral）。具体目标 这项研究的目的是比较循证护理的使用和16周后报告的患者， 转诊。此外，该研究还将评估每种模式下的患者数量和成本 每个模型中的每个患者。 PuSHCon模型结合了以患者为中心的护理、基于团队的护理 并协调专业咨询，以改善COPD高危患者的基于指南的护理 和/或哮喘。这一模式是专门为在安全网系统内运作而开发的。是 设计为实用，并适应于其他CNOHC和CNOHC网络， 资金、技术和资源限制。如果拟议的研究表明PuSHCon模型 增加了循证护理的使用，它可以广泛实施，以增加指南 不仅对COPD或哮喘患者，而且对 其他慢性疾病，将受益于专家咨询。

Project Summary/Abstract The proposed parallel arm, clustered randomized controlled trial will evaluate the effectiveness of a novel model for pulmonary specialist-health coach (PuSHCon) with respect to access to specialist recommendations and the provision of evidence-based care for patients with chronic obstructive pulmonary disease (COPD) and/or asthma receiving care at federally qualified health centers (FQHCs). The PuSHCon model was developed in partnership between patients, investigators, primary care clinicians, specialists, and FQHCs within the San Francisco Health Care Network during a randomized controlled trial of health coaching for patients with moderate to severe COPD. In the PuSHCon model, a trained, non-professional (unliscenced) health worker, meets with the patient at the patient’s own clinic to gather extensive information needed by the pulmonary specialist to make an assessment and recommendation for evidence-based care for COPD and/or asthma. The health coach then meets with the hospital-based pulmonary specialist who can assess the patient and make evidence-based recommendations without requiring the patient to be seen. These recommendations are communicated electronically to the patient’s primary care provider (PCP). The health coach communicates with the PCP and meets with the patient to explain the recommendations and support their implementation. The proposed study will be conducted in the San Francisco Health Network, at 10 clinic sites that share an electronic medical record and a single electronic referral process (eReferral). The specific aims of the study are to compare the use of evidence-based care and of patient reported 16 weeks after the referral. In addition, the study will evaluate the number of patients seen under each model and the cost per patient in each model. The PuSHCon model combines desirable attributes of patient-centered care, team-based care, and coordinated specialty consultation to improve guideline-based care for at-risk patients with COPD and/or asthma. This model has been specifically developed to function within a safety-net system. It is designed to be practical and adaptable to other FQHCs and FQHC networks, and to be effective despite financial, technological, and resource constraints. If the proposed study shows that the PuSHCon model increases the use of evidence-based care, it can be widely implemented to increase guideline concordant, evidence-based care not just for patients with COPD or asthma, but also for patients with other chronic conditions that would benefit from specialist consultation.