Shared Medical Records and Chronic Illness Care

共享医疗记录和慢性病护理

• 批准号: 7249076
• 负责人: JAMES D. RALSTON
• 金额: $ 27.21万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7249076
• 关键词: Shared; Medical; Records; Chronic; Illness

DESCRIPTION (provided by applicant): Effective, ongoing communication between patients and providers is an important component of diabetes and chronic illness care. Patients with diabetes and multiple chronic conditions are particularly dependent on effective communication with a primary physician over time to motivate and troubleshoot care. Unfortunately, our current health care system's focus on the clinic visit does not meet the needs of these patients. Chronic disease care using patient Web portals offers an opportunity to shift the focus in health care away from the office and toward patients' daily lives at home. We propose to evaluate the association between the quality of chronic illness care among patients with diabetes and the use of a Web-based, interactive electronic medical record shared between patients and health care providers. To achieve this goal, we will study a large and secure patient Web portal in the natural setting of care at Group Health Cooperative (Group Health). Group Health's Web portal, MyGroupHealth, allows enrollees to: 1) exchange electronic messages with their entire health care team including physicians; 2) access their electronic medical records in real time; 3) obtain after-visit summaries with embedded hyperlinks to the Healthwise knowledge base; 4) obtain refills on medications with shipping directly to patients' homes; 5) schedule office appointments with providers; and 6) access health education information that is tailored and linked to their specific health conditions. The study will focus on the primary care of patients with diabetes and one or more other chronic conditions. In retrospective analyses, we will first evaluate predictors of portal adoption and whether use of the electronic portal is associated with better clinical quality of care. In a cross-sectional survey of a subsample of this cohort, we will then evaluate whether portal use is associated with better primary care relationships, patient activation and patient's assessment of chronic illness care. Through content analysis, we will evaluate whether the qualities of patient-provider secure messages and patients' after-visit summaries are associated with better chronic illness care. Finally, through qualitative interviews of patients and their primary care providers, we will seek to understand where the Web portal meets and fails to meet patients' needs. Results of this study will help inform the development, evaluation and dissemination of patient Web portals designed to support the care of patients with diabetes and multiple co-morbidities.

描述（由申请人提供）：患者和提供者之间有效、持续的沟通是糖尿病和慢性病护理的重要组成部分。患有糖尿病和多种慢性病的患者尤其依赖于与主治医师长期有效的沟通，以促进护理并解决问题。不幸的是，我们目前的医疗保健系统以门诊就诊为重点，并不能满足这些患者的需求。使用患者门户网站进行慢性病护理提供了将医疗保健的重点从办公室转移到患者在家日常生活的机会。我们建议评估糖尿病患者的慢性病护理质量与患者和医疗保健提供者之间共享的基于网络的交互式电子病历的使用之间的关联。为了实现这一目标，我们将在 Group Health Cooperative (Group Health) 的自然护理环境中研究一个大型且安全的患者门户网站。 Group Health 的门户网站 MyGroupHealth 允许参与者： 1) 与包括医生在内的整个医疗保健团队交换电子消息； 2）实时访问他们的电子病历； 3) 获取带有 Healthwise 知识库嵌入超链接的访问后摘要； 4) 获取药物补充并直接运送到患者家中； 5) 安排与提供者的办公室预约； 6) 获取针对其具体健康状况量身定制的健康教育信息。该研究将重点关注糖尿病和一种或多种其他慢性病患者的初级保健。在回顾性分析中，我们将首先评估门户采用的预测因素以及电子门户的使用是否与更好的临床护理质量相关。在对该队列的子样本进行横断面调查时，我们将评估门户网站的使用是否与更好的初级保健关系、患者的积极性以及患者对慢性病护理的评估相关。通过内容分析，我们将评估患者提供者安全消息的质量和患者的就诊后总结是否与更好的慢性病护理相关。最后，通过对患者及其初级保健提供者进行定性访谈，我们将设法了解门户网站在哪些方面满足了患者的需求，哪些方面未能满足患者的需求。这项研究的结果将有助于为患者门户网站的开发、评估和传播提供信息，该门户网站旨在支持糖尿病和多种合并症患者的护理。