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

项目摘要/摘要 建议的平行对照随机对照试验将评估其有效性。 肺科专科医生-健康教练(PuSHCon)与专科医生接触的新模式 为慢性阻塞性疾病患者提供循证护理的建议 肺部疾病(COPD)和/或哮喘在联邦合格的健康中心(FQHC)接受治疗。 PuSHCon模型是患者、研究人员、初级保健人员合作开发的 旧金山医疗保健网络中的临床医生、专家和FQHC在随机调查期间 健康教育对中重度慢性阻塞性肺疾病患者的对照研究在PuSHCon模型中， 受过培训的非专业(无执照)卫生工作者，在患者自己的诊所与患者会面 收集肺科专家所需的广泛信息，以进行评估和 对慢性阻塞性肺疾病和/或哮喘的循证护理建议。然后健康教练会见了 以医院为基础的肺科专家，他们可以评估患者并进行循证 不需要看病人的情况下的建议。这些建议被传达给 以电子方式发送到患者的初级保健提供者(PCP)。健康教练与初级保健医生沟通 并与患者会面，解释建议并支持其实施。 这项拟议的研究将在旧金山健康网络中进行，在10个诊所地点进行 共享一个电子病历和一个电子推荐流程(EReferral)。具体目标 这项研究的目的是比较循证护理的使用情况和16周后报告的患者 转介。此外，这项研究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模式结合了以患者为中心的护理、基于团队的护理、 协调专科会诊，改善对COPD高危患者的指导方针护理 和/或哮喘。这一模式是专门为在安全网系统内发挥作用而开发的。它是 设计为实用并适用于其他FQHC和FQHC网络，并在 资金、技术和资源方面的限制。如果拟议的研究表明PuSHCon模型 增加循证护理的使用，可广泛实施增加指南 协调一致的循证护理不仅适用于COPD或哮喘患者，也适用于 其他将从专家会诊中受益的慢性疾病。

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.