Comprehensive Management Strategy for GI Disorders

描述（由申请人提供）： 目的：拟议的项目将完善和验证计算机化的自我评估的患者症状和健康相关的生活质量（HRQL）的常见胃肠道（GI）疾病。其目标是改善病人护理，支持研究，并确保护理质量。目前正在使用CarePrep开展工作，这是一个用于患者自我报告健康数据的网络应用程序。研究报告：CarePrep系统地捕获患者直接输入的有关症状和相关心理变量的数据，并测量特定条件的HRQL。为临床医生生成优先级、面向问题的摘要。具体目标是开发和完善针对目标GI障碍（胃酸反流、消化不良、肠易激综合征、炎症性肠病、结肠癌和常见肝胆和胰腺疾病）的评估和HRQL内容;试点测试和进行初步心理测量分析;开发针对临床医生的问题管理特征;增强管理和研究功能;实施重访功能;进行心理测量验证;评估可行性和对护理的影响。在我们迄今为止的工作中，已经为常见的胃肠道疾病开发了一种模型驱动的评估策略，安装在CarePrep中，并进行了试点测试，患者和临床医生都非常认可。研究方法：项目开发将使用标准方法，审查已发表的文书以及专家和患者的意见，后者使用焦点小组和认知访谈，以确保涵盖与患者相关的问题。HRQL评估将使用具有特定条件模块的通用核心。试点测试将收集数据进行心理测量分析和项目减少。经过必要的修改后，将对有效性和临床信度进行检验。CarePrep对临床医生-患者沟通和临床医生有效性的影响将与常规护理进行比较。结论：该系统的改进和验证将证明用于靶向GI障碍的条件特异性评估的综合生物心理社会工具的价值。

DESCRIPTION (provided by applicant): Objectives: The proposed project will refine and validate a computerized self-assessment of patient symptoms and health-related quality of life (HRQL) for common gastrointestinal (Gl) disorders. The goals are to improve patient care, to support research, and to ensure the quality of care. Work is being conducted using CarePrep, a Web application for patient self-reporting of health data. RESEARCH PLAN: CarePrep systematically captures data directly entered by the patient regarding symptoms and relevant psychosocial variables, and measures condition-specific HRQL. A prioritized, problem-oriented summary is generated for the clinician. Specific aims are to develop and refine assessment and HRQL content for the targeted Gl disorders {acid reflux, dyspepsia, irritable bowel syndrome, inflammatory bowel disease, colon cancer, and common hepato-biliary and pancreatic diseases); pilot test and perform preliminary psychometric analysis; develop problem management features for clinicians; enhance administrative and research functions; implement revisit functions; perform psychometric validation; assess feasibility and impact on care. In our work thus far, a model-driven assessment strategy has been developed for common Gl disorders, installed in CarePrep, and pilot tested with excellent acceptance from patients and clinicians. METHODOLOGY: Item development will use standard methodology, with review of published instruments and input from experts and patients, the latter using focus groups and cognitive interviews to ensure that issues of relevance for patients are covered. HRQL assessment will use a generic core with condition-specific modules. Pilot testing will gather data for psychometric analysis and item reduction. After necessary revisions, validity and clinical reliability will be tested. The impact of CarePrep on clinician-patient communication and on clinician effectiveness will be compared to usual care. CONCLUSIONS: The refinement and validation of this system will demonstrate the value of an integrated bio-psychosocial instrument for condition-specific assessment of the targeted Gl disorders.