ED Disability Diagnostic Tool: An HIT Feasibility Study

ED 残疾诊断工具：HIT 可行性研究

• 批准号: 8113183
• 负责人: Lori Ann Post
• 金额: $ 50万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8113183
• 关键词: ED; Disability; Diagnostic; Tool; HIT

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.

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）与现有残疾测量（MOD）研究设计，改善急诊科（艾德）中以健康患者为导向的结局：本多方法研究包括推导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量表的子集用作艾德随机临床试验的简要测量; II）Prosthesis，将残疾评估与面向患者的结果（医疗保健服务利用率和死亡率）联系起来。这项研究将比较诊断，以确定对患者结果和成本的影响。方法学：一个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）开始以来对艾德患者（每天20-30例）进行的所有残疾评估。其次，我们将在艾德记录中对65岁以上患者的残疾进行评分，并根据评估结果检查患者的结局、治疗和转诊情况。第三，我们将研究评估如何影响艾德患者导向的结果。这项研究的回顾性阶段将使我们能够跟踪随后的耶鲁医院和艾德访问，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，以与随机临床试验中的现有MOD进行比较。在研究过程中将招募600名患者，并随机分配到MOD（对照）或RDDT（试验）组。主要患者结局、艾德访视、住院和死亡率将进行量化，以进行比较。我们将估计可预防的艾德就诊和住院的数量，并提供在ED中采用RDDT的成本效益。最后，区域滴滴涕方案将依靠卫生信息技术。本研究的探索性目的将评估工作流程，节省的时间和成本，效率和可用性用于ED。对健康结果的潜在影响：我们预计，一个更好的残疾诊断工具将导致死亡率降低，减少不必要的费用，可预防的艾德访问和住院治疗，以及更好的生活质量为急诊科的患者。 公共卫生相关性：越来越多的老年人和/或残疾人到急诊室就诊，需要对其残疾进行评估，以便进行治疗和适当的转诊。艾德医生常常不知所措，因为这些患者不需要紧急护理或住院治疗，但他们在社区中的失败使他们反复到艾德，在那里他们的需求得不到满足。本研究旨在通过开发和验证一种残疾诊断工具，使艾德医生能够将这些患者与更好的医疗保健转诊、适当的长期护理服务和其他非艾德医疗保健提供者联系起来，从而改善急诊患者的健康状况。