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各种远程提供的服务，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，缺乏专业人员提供否则无法提供的服务。该提案旨在开发一个计算机化的评估系统，能够以类似的方式提供广泛的常用认知测试仪器以及行为-精神测量（BPM）的远程，基于音频-视频的管理，就像考官与被评估对象面对面坐着一样。拟议的远程检查员计算机评估系统（CARES）将使合格的临床医生能够远程进行彻底的神经心理学或精神病学评估的研究对象或患者的一系列获得性脑疾病，这种评估是常规应用，包括：创伤性脑损伤，中风，脑肿瘤，神经毒理学损伤，艾滋病毒相关脑病，精神分裂症和阿尔茨海默病。偏远地区广泛包括农村和大城市地区医院、管理式护理设施、集体实践场所、疗养院、教养设施、区域卫生诊所和患者家中的临床评价单位。CARES将实现一种全新的方法，其中远程检查者查看全屏、应用程序特定的GUI，该GUI提供屏幕上的控制，该控制将使检查者能够：控制测试会话的节奏、重复和补充计算机化指令、立即对口头报告或真实的明显行为进行评分、以及暂停或终止测试。因此，CARES非常适合应用于通常需要持续监测和补充指导的受损人群。值得注意的是，CARES是以前经过验证的双显示器计算机化评估系统的技术扩展，其中受试者由人类检查员陪同。用于该先行系统的GUI将被适配为托管高分辨率电视窗口，该电视窗口允许检查者和患者彼此看到和交谈，建立高质量的“远程呈现”，这对于涉及主观印象或对明显行为的判断的测试或BPM的管理尤其重要。因此，CARES方法与现有的基于网络的评估形成鲜明对比，基于网络的评估不仅没有检查员陪同，而且还存在严格的管理程序以及多种技术缺陷，这些缺陷显著限制了可以可靠地管理给受损个体的测试仪器的范围。在第二阶段，主要目标是：1）开发一个应用程序优化的、标准化的、移动的CARES硬件平台（CHP），集成了外围设备和软件实用程序; 2）比较伴随计算机化测试与远程计算机化测试的并发有效性、重测可靠性和用户可接受性。CARES将是同类系统中的第一个，可能会在一系列医疗保健提供网络、研究环境和对照临床试验中立即获得商业应用。 公共卫生相关性：远程检查员计算机化评估系统是一项独特的高度创新技术，旨在为目前由于地理或经济障碍而“服务不足”的地区提供基于电视的神经心理学和精神病学评估服务，这些障碍限制了获得提供此类服务的经过适当培训的专业人员。在这些服务不足的人群中，有生活在农村地区或偏远地区（如印第安人保留地）的人，被监禁在教养所的人，以及各种“居家”的人，如卧床病人或养老院的居民。需要为这些患者提供否则无法获得的心理健康服务是当前项目希望解决的紧迫差距。