Randomized controlled trial embedded in an electronic health record

描述（由申请人提供）：艾滋病毒/艾滋病是一种无法治愈的慢性疾病。将慢性护理模式（CCM）应用于这种疾病可能会改善门诊护理，并为 HIV 感染患者提供更轻松、更安全的临床过渡。临床信息系统 (CIS) 是 CCM 的关键要素。虽然 CIS 重点关注提供者作为关键数据的接收者，但以患者作为消费者的临床信息系统也可能有助于改善医疗保健。电子个人健康记录 (PHR) 是一种最近但日益常见的、以患者为导向的信息系统，允许患者查看指导实际门诊决策所需的数据，并提供医疗场所之间临床数据的可移植性。我们的假设是，安全的增强型 PHR (ePHR) 结合了有意义的信息、基于网络的支持工具和提醒，也将为促进自我管理提供大量机会，并改善健康结果。在本提案中，我们将直接与公共卫生环境中的艾滋病毒/艾滋病患者合作，对有助于改善患者行为、患者与临床医生信任、临床结果、药物安全和利用等领域健康结果的流程进行建模。因此，具体目标是： 1.（建设基础设施和内容）为在公共卫生环境中接受护理的艾滋病毒/艾滋病患者扩展和保护基于网络的 ePHR，为这些用户提供访问和理解其医疗记录的工具，包括决策支持、信息检索和沟通的资源； 2.（ePHR 评估）评估患者和临床医生对 ePHR 的体验，包括患者访问和使用模式、戒烟支持工具的使用、抑郁减轻、焦虑减少、依从性改善以及患者和临床医生满意度； 3.（结果评估）确定 PHR 在五个领域的使用效果： (a) 临床结果（CD4 T 细胞、可检测的 HIV RNA、抑郁、焦虑、生活质量）； (b) 患者行为（依从性、吸烟）； (c) 互动（信任、促进健康）； (d) 安全性（药物过敏记录、药物协调）； (e) 资源利用（办公室就诊、紧急就诊和住院治疗）。

DESCRIPTION (Provided by Applicant): HIV/AIDS is a non-curable chronic illness. Applying the chronic care model (CCM) to this disease may lead to improved outpatient care and easier, safer clinical transitions for HIV infected patients. Clinical information systems (CIS) are a key element in the CCM. While CIS have focused on the provider as the recipient of critical data, clinical information systems that target patients as consumers might also contribute to improved health care. The electronic personal health record (PHR) is a recent, but increasingly common, patient-oriented information system allowing patients to view data necessary to guide practical outpatient decisions and to provide portability of clinical data between healthcare venues. Our hypothesis is that a secure enhanced PHR (ePHR) that combines meaningful information, web-based tools for support, and reminders will also provide a substantial opportunity to promote self-management and will lead to improved health outcomes. In this proposal we will work directly with HIV/AIDS patients in a public health setting to model processes that contribute to improved health outcomes in the realms of patient behaviors, patient-clinician trust, clinical outcomes, medication safety and utilization. Accordingly, the specific aims are: 1. (Build Infrastructure and Content) Extend and secure a web-based ePHR for HIV/AIDS patients receiving care in a public health setting, providing these users with tools to access and understand their medical records including resources for decision support, information retrieval and communication; 2. (Evaluation of ePHR) Evaluate patient and clinician experience with ePHR including patient access and use patterns, use of support tools for tobacco cessation, depression abatement, anxiety reduction, adherence improvement, and patient and clinician satisfaction; 3. (Outcome Assessment) Determine the effect of PHR use in five domains: (a) Clinical outcomes (CD4+T cells, detectable HIV RNA, depression, anxiety, quality of life); (b) Patient behaviors (adherence, tobacco use); (c) Interaction (trust, health promotion); (d) Safety (documentation of drug allergies, medication reconciliation); and (e) Utilization of resources (office visits, emergency visits and hospitalizations).