Incorporating PRO Data into RA Clinical Encounters using Health-IT (PACT)

项目概要/摘要 患者报告结局（PRO）数据的有效使用预计将在改善 医疗保健提供、患者护理体验和结果。在类风湿性关节炎（RA）中， 以关节疼痛和炎症为特征的慢性疾病，过去已使用经验证的PRO 数十年来评估RA疾病活动水平和功能状态。PRO的常规评估是 美国流变学学会（ACR）指南现在推荐，质量措施， 鼓励定期收集RA PRO已得到国家质量论坛的认可。治疗 RA的算法依赖于PRO来指导关于使用疾病改善药物的临床决策。虽然 已知在RA中有效使用PRO数据可改善健康结局， RA是不一致的。现有的电子健康记录（EHR）无法有效导入PRO数据， 以医生和患者易于理解的方式可视化PRO。 作为对SEN（NOT-HS-16-015）的回应，使用健康- IT（PACT）研究旨在构建应用程序（使用通过应用程序获得的实时EHR数据 编程接口）以可视地表示患有RA的个体的疾病过程，包括临床和 在可接受的临床目标背景下构建的患者报告信息。我们将与 专业设计团队与患者和临床医生合作，开发原型前端用户界面 可用于在常规临床护理期间将PRO数据传达给患者和临床医生（目标1）。我们 然后，我将与我们的临床信息学团队合作，在2个卫生系统中构建应用程序，并对其进行测试， 可接受性和对临床工作流程的影响（目标2）。最后，我们将测试使用PRO的假设， 在临床过程中的应用将改善过程和健康结果， 结果，包括药物依从性和共同决策，为RA患者使用务实的 试验设计（目标3）。 将PRO数据的实时、易于解释的可视化结果应用于临床具有巨大的潜力 增加患者参与和共同决策，并将推动采用经验证的策略 （“达标治疗”），以改善健康结果和减少残疾。本研究旨在开发可扩展的健康 信息技术干预措施，以填补目前在实践中使用PRO数据方面的差距， 130万美国人患有风湿性关节炎

Project Summary/Abstract The effective use of patient-reported outcomes (PROs) data is anticipated to play a critical role in improving health care delivery, patient experiences with care, and outcomes. In rheumatoid arthritis (RA), a complex chronic condition characterized by joint pain and inflammation, validated PROs have been used over the past several decades to assess levels of RA disease activity and functional status. Routine assessment of PROs is now recommended by American College of Rheumatology (ACR) guidelines, and quality measures to encourage the regular collection of RA PROs have been endorsed by the National Quality Forum. Treatment algorithms for RA rely on PROs to guide clinical decisions around use of disease-modifying drugs. Although the effective use of PRO data in RA is known to improve health outcomes, the routine use of PROs in patients with RA is inconsistent. Existing electronic health records (EHRs) are unable to effectively import PRO data or visualize PROs in a way that physicians and patients can easily understand. In response to SEN (NOT-HS-16-015), the Incorporating PRO Data into RA Clinical Encounters using Health- IT (PACT) study aims to build an application (using real-time EHR data obtained via an application programming interface) to visually represent the disease course of an individual with RA, including clinical and patient-reported information that is framed within the context of accepted clinical targets. We will engage a professional design team to work with patients and clinicians to develop a prototype front-end user-interface that can be used to communicate PRO data to patients and clinicians during routine clinical care (Aim 1). We will then work with our clinical informatics teams to build the application in 2 health systems and test them for acceptability and effects on clinical work flow (Aim 2). Finally, we will test the hypothesis that use of the PRO application during a clinical encounter will improve process and health outcomes, and patient-centered outcomes including medication adherence and shared decision making, for patients with RA using a pragmatic trial design (Aim 3). Incorporating real-time, easy-to-interpret visualizations of PRO data into clinical encounters has great potential to increase patient engagement and shared-decision making, and will drive the adoption of proven strategies (“treat-to-target”) to improve health outcomes and reduce disability. This study aims to develop scalable health IT interventions to fill the current gap in use of PRO data in practice, with the goal of improving outcomes for the 1.3 million Americans with RA.