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

项目概要/摘要 拟议的平行臂、集群随机对照试验将评估有效性 肺部专科健康教练 (PuSHCon) 的新模式在接触专科医生方面的研究 为慢性阻塞性肺疾病患者提供建议和循证护理 肺部疾病 (COPD) 和/或哮喘在联邦合格的健康中心 (FQHC) 接受护理。 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内的临床医生、专家和 FQHC 在随机 针对中度至重度慢性阻塞性肺病患者的健康指导对照试验。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 收集肺部专家进行评估所需的大量信息 针对慢性阻塞性肺病和/或哮喘的循证护理建议。然后健康教练会见 医院的肺部专家可以评估患者并做出基于证据的 无需见患者就可提出建议。这些建议已传达 以电子方式发送给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，解释建议并支持其实施。 拟议的研究将在旧金山健康网络的 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 该研究的目的是比较循证护理的使用情况以及治疗后 16 周报告的患者情况 转介。此外，该研究还将评估每种模式下就诊的患者数量以及成本 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，以改善对慢性阻塞性肺病高危患者的基于指南的护理 和/或哮喘。该模型是专门为在安全网系统中运行而开发的。它是 设计实用且适用于其他 FQHC 和 FQHC 网络，并且即使在 财务、技术和资源限制。如果拟议的研究表明 PuSHCon 模型 增加循证护理的使用，可以广泛实施以增加指南 一致的、基于证据的护理不仅适用于慢性阻塞性肺病或哮喘患者，也适用于患有以下疾病的患者 其他需要专家咨询的慢性病。

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.