COMPUTERIZED PATIENT SELF-ASSESSMENT FOR RHEUMATOLOGY

描述（由申请人提供）：拟议的工作开发内容和测试CarePrep的可行性，CarePrep是一种基于Web的患者自我评估工具，用于类风湿关节炎（RA）患者。类风湿关节炎是一种常见的疾病，通常会导致功能迅速丧失，但早期积极的治疗可以改善预后。测量健康相关生活质量（HRQL）的工具可用于评估RA人群的治疗，并可能用于监测和调整个体患者的治疗。虽然纸HRQL工具很难使用，基于Web的工具提供了一个有吸引力的方法。 CarePrep面试已经建立了一般医疗和胃肠病学评估。CarePrep使用模块化设计，其中每个元素都可以配置。可以为各种临床或研究任务制作配置文件;在预约时间选择配置文件。目的：1）将HRQL、关节炎特异性健康评估问卷（HAQ）和通用兰德-36（或简表36）的成熟工具安装到CarePrep中。还将开发一个精简的HRQL工具（CPQL），其中包括筛选问题和配置的分支。 现有的CarePrep系统审查（ROS）将适用于表征症状，识别疾病活动的关节外部位并检测潜在的药物毒性。一个图形将收集病人衍生的招标关节计数，疾病活动的可靠指标。 一个修改后的德尔菲过程将被用来组织专家的评论。CarePrep输出为优先级、面向问题的报告，旨在进行有效的医生审查;将包括关节计数和HRQL领域的评分。2)该应用程序将进行试点测试，并举行焦点小组会议。3)测试100例RA患者，ROS的准确性将通过CarePrep报告的医生评级进行评估。 将通过绕过分支阈值评估筛选CPQL问题的敏感性，以便询问所有HRQL问题。将患者的CarePrep关节计数与医生计数进行比较。4)将进行可行性测试，模拟CarePrep在实践环境中的预期使用。患者将进行计算机访问，然后评估体验。执业医师将审查报告，评估患者，然后评估报告的实用性。我们预计CarePrep将被患者和医生很好地接受，并提供有效的RA状态监测，从而实现更具成本效益的护理。

DESCRIPTION (provided by applicant): Proposed work develops content and tests the feasibility of CarePrep, a Web-based patient self-assessment instrument, in patients with rheumatoid arthritis (RA). RA is a common disorder that usually causes rapid loss of function, but early, aggressive treatment improves outcomes. Instruments that measure health-related quality of life (HRQL) are useful to assess treatment in RA populations, and probably are useful in monitoring and adapting therapy in individual patients. Whereas paper HRQL instruments are difficult to use, Web-based instruments provide an attractive approach. The CarePrep interview has already been built for general medical and gastroenterological assessment. CarePrep uses a modular design wherein every element can be configured. Configuration profiles can be crafted for a variety of clinical or research tasks; profiles are selected at appointment time. Aims: 1) The well-established instruments for HRQL, the arthritis-specific Health Assessment Questionnaire (HAQ) and the generic RAND-36 (or Short Form 36) will installed into CarePrep. A streamlined HRQL tool (CPQL) with screening questions and configured branching will also be developed. The existing CarePrep review of systems (ROS) will be adapted to characterize symptoms, identifying extraarticular sites of disease activity and detecting potential drug toxicity. A graphic will gather patient-derived tender joint counts, a reliable index of disease activity. A modified Delphi process will be used to structure critique by experts. The CarePrep output is prioritized, problem-oriented report designed for efficient physician review; scores for joint counts and HRQL domains will be included. 2) The application will be pilot tested and focus groups held. 3) Testing 100 RA patients, accuracy of the ROS will be assessed by physician rating of CarePrep reports. The sensitivity of screening CPQL questions will be assessed by bypassing branching thresholds so that all HRQL questions will be asked. The patient's CarePrep joint count will be compared to a physician count. 4) Feasibility testing will be conducted that mimics anticipated use of CarePrep in practice settings. Patients will do the computer interview and then evaluate the experience. Practicing physicians will review the report, evaluate the patient, and then assess the utility of the report. We anticipate that CarePrep will be well accepted by patients and physicians and provide efficient monitoring of RA Status, thereby allowing more cost-effective care.