Technology for Optimizing Population Care in a Resource-limited Environment

在资源有限的环境中优化人口护理的技术

• 批准号: 7942748
• 负责人: STEVEN J Atlas
• 金额: $ 41.19万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7942748
• 关键词: Technology; Optimizing; Population; Care; Resource

DESCRIPTION (provided by applicant): Our health care system is frequently seen as too costly, fragmented, inefficient, and unsafe. Efforts to improve health care in the primary care setting can be facilitated by patient registries and information technology (IT) that expand care beyond traditional one-on-one visits. However, the most effective and efficient approaches to implementing health IT systems for primary care population management are not currently known. We propose to test the hypothesis that an IT platform that integrates electronic health record data can efficiently leverage the unique knowledge clinicians have about their patients to enhance care. Specifically, we will examine the value of matching the "right" provider for a given patient within a novel informatics platform that facilitates cancer prevention between office visits. This hypothesis will be tested in a randomized clinical trial of preventive breast, cervical, colorectal and prostate cancer screening within our primary care practice based research network (PBRN). In intervention practices for eligible patients overdue for screening, clinicians (physicians and clinical population managers) will use a web-based tool to review their patient list, and with "one click" select a screening decision based upon the patient's unique risk profile. Tailored outreach, including letters, shared decision making aids, practice personnel or patient navigator contact, will efficiently improve screening rates by better linking outreach to the patient's needs compared to control patients. For the control group, we will define a standard of augmented care that mimics current population-level reminder systems supplemented by the use of automation. This will involve a centralized process to mail letters to all patients who appear overdue for screening without provider review. The system will automatically track completed tests and only notify practice personnel to contact patients if screening is not completed within a specified time. For patients remaining overdue, patient navigators will evaluate and contact only high risk control patients. The following Specific Aims will be tested: Specific Aim 1: To design, develop, and implement a novel cancer screening intervention program called Technology for Optimizing Population Care in A Resource-limited Environment (TOP-CARE) that facilitates the identification, individualized contact, and subsequent tracking of patients overdue for screening. Specific Aim 2: To conduct a practice randomized trial of the TOP-CARE program within our PBRN assessing its impact on cancer screening rates in eligible patients. Specific Aim 3: To prospectively collect data during the randomized trial about the costs, preferences, and clinical and process outcomes to inform a subsequent formal cost-benefit analysis. This research is relevant to nationwide efforts, such as the patient-centered medical home, to rigorously demonstrate the most effective and efficient ways to implement novel IT-based health delivery models to provide high quality population-based primary care within resource-limited health care settings.

描述（由申请人提供）：我们的医疗保健系统经常被认为成本过高、分散、效率低下且不安全。患者登记和信息技术 (IT) 可以促进改善初级保健环境中的医疗保健工作，从而将护理范围扩展到传统的一对一就诊之外。然而，目前尚不清楚实施卫生信息技术系统以进行初级保健人口管理的最有效和高效的方法。我们建议测试这样一个假设：集成电子健康记录数据的 IT 平台可以有效地利用临床医生对患者的独特知识来加强护理。具体来说，我们将研究在一个新颖的信息学平台中为特定患者匹配“正确”的提供者的价值，该平台有助于在就诊期间预防癌症。这一假设将在我们基于初级保健实践的研究网络 (PBRN) 内进行的预防性乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查的随机临床试验中得到检验。在对逾期筛查合格患者的干预实践中，临床医生（医生和临床人群管理者）将使用基于网络的工具来审查其患者名单，并通过“一键点击”根据患者独特的风险状况选择筛查决策。与对照患者相比，量身定制的外展活动，包括信件、共享决策辅助工具、执业人员或患者导航员联系，将通过更好地将外展活动与患者的需求联系起来，有效提高筛查率。对于对照组，我们将定义一个增强护理标准，模仿当前人口级别的提醒系统，并辅以自动化。这将涉及一个集中流程，向所有逾期筛查且未经提供者审查的患者邮寄信件。系统将自动跟踪已完成的测试，并且仅在筛查未在指定时间内完成时才通知执业人员联系患者。对于逾期的患者，患者导航员将仅评估和联系高风险控制患者。将测试以下具体目标： 具体目标 1：设计、开发和实施一项名为“资源有限环境中优化人群护理技术”(TOP-CARE) 的新型癌症筛查干预计划，该计划有助于对逾期筛查的患者进行识别、个性化联系和后续跟踪。具体目标 2：在我们的 PBRN 内进行 TOP-CARE 计划的实践随机试验，评估其对符合条件的患者的癌症筛查率的影响。 具体目标 3：在随机试验期间前瞻性地收集有关成本、偏好以及临床和过程结果的数据，为随后的正式成本效益分析提供信息。这项研究与全国范围内的努力相关，例如以患者为中心的医疗之家，严格论证实施基于信息技术的新型医疗服务模式的最有效和最高效的方法，以便在资源有限的医疗保健环境中提供高质量的基于人口的初级保健。