Randomized controlled trial embedded in an electronic health record

描述(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，并使艾滋病毒感染患者更容易、更安全地过渡到临床。临床信息系统(CIS)是CCM的重要组成部分。虽然独联体将重点放在作为关键数据接收者的提供者上，但以患者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)是一种最近但日益普遍的以患者为导向的信息系统，允许患者查看必要的数据，以指导实际的门诊决策，并提供医疗保健场所之间的临床数据的便携性。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，也将提供一个促进自我管理的实质性机会，并将导致改善健康结果。在这项提案中，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，建立有助于改善患者行为、患者与临床医生之间的信任、临床结果、用药安全性和利用率等领域的健康结果的过程模型。因此，具体目标是： 1.(建立基础设施和内容)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了解其医疗记录的工具，包括用于决策支持、信息检索和交流的资源； 2.(ePHR评估)评估患者和临床医生使用ePHR的体验，包括患者访问和使用模式、戒烟支持工具的使用、抑郁缓解、焦虑减轻、依从性改善以及患者和临床医生的满意度； 3.(结果评估)在五个领域确定使用PHR的效果：(A)临床结果(CD4T细胞、可检测到的艾滋病毒RNA、抑郁、焦虑、生活质量)；(B)患者行为(坚持、吸烟)；(C)互动(信任、健康促进)；(D)安全性(药物过敏记录、药物调节)；和(E)资源利用(办公室访问、紧急访问和住院)。

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).