Conversational IT for Better, Safer Pediatric Primary Care

有效的儿童初级保健的建议和实际需要之间存在很大差距 在儿科初级保健环境中，特别是在预防保健领域。此外，虽然药物治疗 管理(安全和有效性)问题已经成为儿童的一个重要因素，人们对此知之甚少 家庭在家中实际使用药物的情况。交互式电话技术提供了潜在的高度 有效的、以患者为中心的沟通方式，通过互动讨论引导在家的父母 可以收集信息并积极加强建议和治疗。交互式电话系统是 特别适合在弱势群体中使用，因为电话几乎是普遍的，而且 系统不依赖于阅读打印文本。我们建议开发和评估以患者为中心的综合 健康信息系统，个人健康合作伙伴(PHP)。PHP将使用全自动、交互式、 在预定的探视之前收集个人健康数据并向父母提供咨询的对话，与 儿童？S初级保健临床医生通过电子健康档案(EHR)，并提供个性化的随访评估和 探视后的咨询。 个人健康伙伴系统将在随机临床试验中进行评估，以确定何时 与常规护理相比：1)合并了PHP预防和用药管理评估(没有咨询) 通过EHR数据交换实现更高质量的预防护理和药物管理；以及2)通过 自动化咨询还与更多的父母活跃和更健康的父母行为有关。 我们还将探讨：1)家长和临床医生是否可以使用PHP系统；2)有以下情况的家长 健康素养低的人能够像健康素养高的人一样有效地使用PHP系统；3)父母 接受PHP评估和咨询的人比那些接受咨询或改变行为的人更有可能 只接受PHP评估；以及4)PHP系统可以在新的 初级保健环境中的处方。 将在该项目中评估的基于IT的方法将在临床环境之外的父母和儿童之间建立联系 他们的初级保健中心，将提供全面的评估和咨询，以加强和支持父母 行为改变。随着电子病历的使用越来越多，出现了将以患者为中心的信息与 临床健康信息系统。这些系统的联系有可能通知和激活父母，提供 更丰富的数据，以推动医疗保健点的决策支持，并为长期行为提供持续支持 在初级保健就诊后发生变化。使用对话技术作为项目的基础提供了一个 一些独特的优势，特别是对识字率较低的人口的支持和近乎普及的机会。 像PHP这样的系统代表了未来门诊护理和可持续、负担得起的 未来初级保健临床医生提供更高质量和更安全的护理。

A large gap exists between what is recommended for effective primary care of children and what actually takes place in pediatric primary care settings, especially in the areas of preventive care. Furthermore, although medication management (safety and effectiveness) issues have emerged as an important factor for children, little is known about how medication is actually used by families at home. Interactive telephony technologies offer a potentially highly effective, patient-centered communication modality by guiding parents at home through interactive discussions that can gather information and actively reinforce recommendations and treatments. Interactive telephony systems are particularly well suited for use in vulnerable populations since access to the telephone is nearly universal, and the system does not rely on reading printed text. We propose to develop and evaluate an integrated patient-centered health information system, the Personal Health Partner (PHP). The PHP will use fully automated, interactive, conversations to gather personal health data and counsel parents before scheduled visits, exchange that data with the child?s primary care clinician via the electronic health record (EHR), and offer personalized follow-up assessment and counseling after visits. The Personal Health Partner System will be evaluated in a randomized clinical trial to determine whether when compared to usual care: 1) PHP preventive and medication management assessments (without counseling) combined with EHR data exchange lead to higher quality preventive care and medication management; and 2) PHP with automated counseling is also associated with increased parental activation and healthier parental behaviors. We will also explore whether: 1) use of the PHP system will be feasible for parents and clinicians; 2) parents with low health literacy are able to use the PHP system as effectively as those with higher health literacy; 3) parents who receive PHP assessments with counseling are more likely to be counseled or change their behavior than those who receive PHP assessment only; and 4) the PHP system can automatically detect medications errors following new prescriptions in primary care settings. The IT-based approach to be evaluated in this project will link parents and children outside the clinical setting with their primary care center and will offer comprehensive assessments AND counseling to reinforce and support parental behavior change. With growing use of the EHR come new opportunities to link patient-centered information with clinical health information systems. Linkage of these systems has the potential to inform and activate parents, provide much richer data to drive decision support at the point-of-care, and to provide ongoing support for long-term behavior change following primary care visits. The use of conversational technologies as the foundation for the project offers a number of unique advantages especially the support of lower-literacy populations and near-universal access. Systems like the PHP represent a model for the future of ambulatory care and the sustainable, affordable delivery of higher quality and safer care by primary care clinicians in the future.