ED Disability Diagnostic Tool: An HIT Feasibility Study

描述（由申请人提供）：通过推导、验证和比较Rasch残疾诊断工具（RDDT）与现有的残疾测量（MOD）研究设计，改善急诊科（ED）以患者为导向的健康结果：这项多方法研究包括推导出Rasch残疾量表：I)使用RDDT对残疾指标进行回顾性评分，验证RDDT，选择Rasch量表的一个子集作为ED随机临床试验的简要衡量标准；二)前瞻性地将残疾评估与以病人为导向的结果（卫生保健服务的利用和死亡率）联系起来。这项研究将比较诊断，以确定对患者预后和成本的影响。方法：专家小组将确定残疾诊断工具的内容，将创建Rasch量表，在回顾性阶段对现有医院记录中的残疾进行评分。首先，我们将检索自耶鲁纽黑文医院电子数据收集系统（2005年4月）建立以来对急诊科患者进行的所有残疾评估（每天20-30例）。其次，我们将在60至65岁患者的急诊记录中对残疾进行评分，并根据评估结果检查患者的预后、治疗和转诊。第三，我们将研究评估如何影响ED患者导向的结果。本研究的回顾性阶段将使我们能够跟踪随后的耶鲁医院和急诊科就诊、治疗和健康结果。在回顾性分析中开发的简短、准确和精确的RDDT将用于前瞻性阶段，与随机临床试验中现有的MOD进行比较。在整个研究过程中，将招募600名患者并随机分配到MOD（对照组）或RDDT（试验组）组。同意的研究对象，包括急诊科患者、家属和患者医疗保健提供者将被随访两个月。患者的主要结果、急诊科就诊、住院率和死亡率将被量化以进行比较。我们将估计可预防的急诊科就诊和住院的数量，并提供在急诊科采用RDDT的成本效益。最后，区域滴滴涕将依靠卫生信息技术。本研究的探索性目的是评估急诊科的工作流程、时间和成本节约、效率和可用性。对健康结果的潜在影响：我们期望更好的残疾诊断工具能降低死亡率，减少不必要的成本，预防急诊科就诊和住院，提高急诊科患者的生活质量。

DESCRIPTION (provided by applicant): To improve health patient oriented outcomes in Emergency Departments (ED) by deriving, validating, and comparing the Rasch Disability Diagnostic Tool (RDDT) to existing Measure of Disability (MOD) Research Design: This multi methodological study includes deriving a Rasch scale of disability: I) Using the RDDT to retrospectively score disability indicators, validating the RDDT, selecting a subset of the Rasch scale to be used as a brief measure for an ED randomized clinical trial; II) Prospectively, linking disability assessments to patient oriented outcomes (health care service utilization and mortality). This study would compare diagnoses to determine impact on patient outcomes and costs. Methodology: An expert panel would determine content for the disability diagnostic tool, Rasch scales would be created to score disability in existing hospital records in the retrospective phase. First, we would retrieve all disability assessments performed on ED patients (20-30 per day) since the inception of the electronic data collection system at Yale New Haven Hospital (April 2005). Second, we would score disability in ED records for patients > 65 years and examine patient outcomes, treatments and referrals based on the assessment. Third, we would examine how the assessment impacted ED patient oriented outcomes. The retrospective phase of this study would allow us to track subsequent Yale hospital and ED visits, treatments, and health outcomes. A brief accurate and precise RDDT, developed in the retrospective analysis would be used for the prospective phase to compare with the existing MOD in a randomized clinical trial. 600 patients would be recruited over the course of the study and randomly allocated into the MOD (control) or RDDT (test) arm. Consented study subjects, including ED patients, families, and patient health care providers would be followed for two months. The primary patient outcomes, ED visits, hospital admits, and mortality would be quantified for comparative purposes. We would estimate the number of preventable ED visits and hospitalizations and provide a cost benefit for adopting the RDDT in EDs. Finally, the RDDT would rely on health information technology. The exploratory aim of the study would assess work flow, time and cost savings, efficiency and usability for use in the ED. Potential Impact on Health Outcomes: We expect that a better disability diagnostic tool would lead to lower mortality, a reduction in unnecessary costs, preventable ED visits and hospitalizations, and a better quality of life for patients presenting to Emergency Departments. PUBLIC HEALTH RELEVANCE: Increasing numbers of elderly and/or disabled persons are presenting to Emergency Departments (ED) that require an assessment of their disabilities for treatment and proper referral. ED physicians are often at a loss because these patients do not require acute care or hospitalization yet their failure to thrive in the community brings them repeatedly to the ED where their needs are not being met. This study aims to improve the health outcomes of persons presenting to EDs by developing and validating a disability diagnostic tool that would allow ED physicians to connect these patients to better health care referrals, proper long term care services, and other non-ED health care providers.