Computerized Assessment by Remote Examiner System (CARES)

远程检查系统计算机化评估（CARES）

• 批准号: 8141230
• 负责人: JAMES P O'HALLORAN
• 金额: $ 43.81万
• 依托单位: NEUROCOMP SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-02-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8141230
• 关键词: Address; Alzheimer' s Disease; Area; Behavior; Behavioral; Brain Diseases; Brain Neoplasms; Businesses; Clinic; Clinical Data; Clinical Research; Clinical Trials; Cognitive; Complex; Computer software; Computerized Medical Record; Computers; Controlled Clinical Trials; Data; Development; Devices; Distal; Economics; Electronics; Ensure; Evaluation; Evaluation Research; Foundations; Goals; Group Practice; HIV; Health; Healthcare Systems; Home environment; Hospitals; Human; Imprisonment; Indian reservation; Individual; Instruction; Interview; Judgment; Left; Life; Location; Logic; Managed Care; Measures; Medication Management; Mental Health Services; Monitor; Neurocognitive; Nursing Homes; Online Systems; Patients; Performance; Peripheral; Phase; Population; Procedures; Psychometrics; Qualifying; Reporting; Research; Research Infrastructure; Research Subjects; Resolution; Running; Rural; Schedule; Schizophrenia; Services; Side; Site; Solutions; Standardization; Stroke; System; Systems Development; Telemedicine; Testing; Time; Training; Traumatic Brain Injury; Underserved Population; Visit; base; clinical research site; commercial application; computerized; cost; data exchange; data format; data management; design; field study; health care delivery; impression; innovation; innovative technologies; instrument; interoperability; meetings; metropolitan; neuropsychological; novel; novel strategies; public health relevance; research clinical testing; response; rural area; wireless network

DESCRIPTION (provided by applicant): Telemedicine can be defined as the delivery of healthcare services to distal locations by electronic connectivity. In recent years, telemedicine has expanded to include a wide range of remotely delivered services, including vital signs monitoring, medication management, "telepsychiatry" and others. The increasing utilization of telemedicine is driven by cost and, for distal ("underserved") regions, a lack of professionals to deliver otherwise unavailable services. This proposal aims to develop a computerized assessment system capable of providing remote, audio-video-based administration of a wide range of commonly applied cognitive test instruments as well as behavioral-psychiatric measures (BPMs), in a similar manner as if the examiner were sitting face-to-face with the subject being evaluated. The proposed Computerized Assessment by Remote Examiner System (CARES) will enable qualified clinicians to remotely conduct thorough neuropsychological or psychiatric evaluations of research subjects or patients with a range of acquired brain disorders for which such assessments are routinely applied, including: traumatic brain injury, stroke, brain tumor, neurotoxicologicalinsult,HIV-relatedencephalopathy,schizophrenia,and Alzheimer's disease. Remote locations broadly include clinical evaluation units at hospitals, managed care facilities, group practice sites, nursing homes, correctional facilities, regional health clinics, and in patient's homes, in both rural and metropolitan areas. The CARES will implement a fundamentally new approach in which a remote examiner views a full-screen, application-specific GUI that provides on- screen controls that will enable an examiner to: control the pace of the test session, repeat and supplement computerized instructions, immediately score verbal report or overt behavior in real time, and pause or terminate a test. Thus, the CARES is well suited for application in impaired populations that commonly require ongoing monitoring and supplemental instruction. Significantly, the CARES is a technological extension of a previously validated, dual-display, computerized assessment system in which the subject is physically accompanied by a human examiner. The GUI for this antecedent system will be adapted to host a high-resolution televideo window that permits an examiner and patient to see and talk to each other, establishing high-quality "telepresence", which is especially important for the administration of tests or BPMs involving subjective impressions or judgement of overt behavior. Accordingly, the CARES approach contrasts sharply with available, web-based assessments that are not only unaccompanied by an examiner, but suffer from rigid administration procedures, as well as multiple technical shortcomings, that significantly limit the range of test instruments that can be reliably administered to impaired individuals. In Phase II, the main objectives are to: 1) develop an application- optimized, standardized, mobile CARES Hardware Platform (CHP) with integrated peripheral devices and software utilities; and 2)compare the concurrent validity, test-retest reliability, and user acceptability of accompanied computerized testing vs. remote computerized testing. The CARES will be the first system of its kind and will likely find immediate commercial application across a range of healthcare delivery networks, research settings, and controlled clinical trials. PUBLIC HEALTH RELEVANCE: The Computerized Assessment by Remote Examiner System (CARES) is a unique and highly innovative technology intended to facilitate televideo-based neuropsychological and psychiatric evaluation services in areas that are currently "underserved" due to either geographic or economic obstacles that limit access to properly trained professionals who provide such services. Among these underserved populations are individuals living in rural areas or remote regions such as Indian reservations, individuals incarcerated in correctional facilities, and a variety of "homebound" individuals such as non-ambulatory patients or residents of nursing homes. The need to provide otherwise unavailable mental health services to these patients is a pressing disparity that the current project hopes to address.

描述（由申请人提供）：远程医疗可以定义为通过电子连接向远端位置提供医疗保健服务。近年来，远程医疗已扩大到包括范围广泛的远程提供服务，包括生命体征监测、药物管理、“远程精神病学”等。越来越多地利用远程医疗是由成本驱动的，对于偏远（“服务不足”）地区，缺乏专业人员来提供否则无法获得的服务。该提案旨在开发一种计算机化的评估系统，该系统能够以类似的方式提供远程，基于音频视频的管理，广泛应用于认知测试工具以及行为精神病学测量（bpm），就像考官与被评估对象面对面坐在一起一样。远程审核员系统（CARES）提出的计算机化评估将使合格的临床医生能够远程对研究对象或患有一系列获得性脑部疾病的患者进行彻底的神经心理学或精神病学评估，这些评估通常适用于：创伤性脑损伤、中风、脑肿瘤、神经毒理学损伤、hiv相关脑病、精神分裂症和阿尔茨海默病。偏远地区广泛包括医院、管理护理设施、团体诊所、养老院、教养设施、区域卫生诊所以及农村和大都市地区的病人家中的临床评估单位。CARES将实现一种全新的方法，远程审查员可以查看一个全屏的、特定于应用程序的GUI，该GUI提供了屏幕上的控制，使审查员能够：控制测试会话的速度，重复和补充计算机指令，实时立即对口头报告或公开行为进行评分，暂停或终止测试。因此，CARES非常适合在通常需要持续监测和补充指导的受损人群中应用。值得注意的是，CARES是先前经过验证的双显示计算机化评估系统的技术扩展，在该系统中，受试者由人类考官陪同。这个先行系统的GUI将被改造成一个高分辨率的电视视频窗口，允许考官和病人彼此看到和交谈，建立高质量的“远程呈现”，这对于涉及主观印象或公开行为判断的测试或bpm管理尤其重要。因此，CARES方法与现有的基于网络的评估形成鲜明对比，后者不仅没有审查员陪同，而且管理程序严格，而且存在多种技术缺陷，严重限制了可以可靠地向受损个人提供的测试工具的范围。在第二阶段，主要目标是：1)开发一个应用程序优化，标准化，移动关怀硬件平台（CHP）与集成的外围设备和软件实用程序；2)比较陪同计算机化测试与远程计算机化测试的并发效度、重测信度和用户接受度。CARES将是同类系统中的第一个，可能会在一系列医疗保健服务网络、研究机构和对照临床试验中立即找到商业应用。