ParentLink: Better and Safer Emergency Care for Children

描述（由申请人提供）：拟议的工作是根据医学研究所患者安全数据标准委员会的授权进行的，该委员会敦促卫生系统向临床医生及其患者提供完整的患者信息和决策支持。本应用程序名为ParentLink：为儿童提供更好和更安全的紧急护理，重点关注医疗保健研究和质量机构发布的申请请求（RFA）中突出的两个具体领域：1)主题1.9，利益相关者使用医疗信息技术的利弊；2)主题5.1，为HIT生成新的知识和证据。急诊科（ED）构成了错误和低质量护理的高风险环境。儿科患者发生医疗差错的风险增加。申请人认为，实施以患者为中心的健康信息技术ParentLink，可以解决系统层面的缺陷，以及急诊科医生和患病儿童父母独特的“及时”信息需求。拟议的工作提供了一种创新产品：一个与儿科知识库相连接的电子界面，该知识库将来自家长的数据与针对五种常见儿科疾病的安全有效急诊护理的最佳做法相结合。这些疾病包括：1)隐匿性菌血症；2)中耳炎；3)尿路感染；4)哮喘;还有头部外伤。该研究有两个目的，第一个是解决数据获取方面的关键差距：该项目将评估症状、疾病状况、药物和过敏信息的完整性和准确性，这些信息是由父母使用ParentLink生成的，而不是由急诊科医生和护士记录的信息，采用结构化电话访谈作为黄金标准。第二个目标是衡量ParentLink对急诊科患者安全和质量的影响，具体而言：a)急诊科护理期间订购和处方药物的错误率；b)遵循国家循证指南的急诊科就诊比例。ParentLink将在两个不同ED地点的临床试验中进行严格评估，采用顺序，非随机观察设计，两个干预和两个控制期，以测量ParentLink对数据捕获和患者护理的安全性和质量的影响。

DESCRIPTION (provided by the applicant): The proposed work is informed by a mandate from the Institute of Medicine's Committee on Data Standards for Patient Safety which urges health systems to provide complete patient information and decision support to clinicians and their patients. This application, ParentLink: Better and Safer Emergency Care for Children, focuses on two specific areas highlighted in this Request for Applications (RFA) published by the Agency for Healthcare Research and Quality: 1) topic 1.9, the advantages and disadvantages of HIT use amongst stakeholders; and 2) topic 5.1, the generation of new knowledge and evidence for HIT. The emergency department (ED) constitutes a high-risk environment for errors and poor quality of care. Pediatric patients are at increased risk of medical errors. This applicant postulates that implementation of a patient-centered health information technology, ParentLink, can address system-level deficiencies and the unique "just-in-time" information needs of ED physicians and the parents of ill children. The proposed work delivers an innovative product: an electronic interface linked to a pediatric knowledge base that integrates parent-derived data with best practices for safe and effective emergency care across five common pediatric disease conditions. These disease conditions include: 1) occult bacteremia; 2) otitis media; 3) urinary tract infections; 4) asthma; and 5) head trauma. The study has two aims, the first of which addresses critical gaps in data capture: this project will evaluate the completeness and accuracy of information on symptoms, disease condition, medications and allergies generated by parents using ParentLink versus information documented by ED physicians and nurses, using structured telephone interviews as a gold standard. The second aim measures the ParentLink's impact on ED patient safety and quality, specifically: a) the error rate for ordering and prescribing of medications during ED care; and b) the percent of ED visits that adhere to national evidence-based guidelines. ParentLink will be rigorously evaluated in a clinical trial at two diverse ED sites, using a sequential, non-randomized observational design with two intervention and two control periods to measure effects of ParentLink on data capture and the safety and quality of patient care.