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)：远程医疗可被定义为通过电子连接向远端地点提供医疗服务。近年来，远程医疗已扩大到包括广泛的远程交付服务，包括生命体征监测、用药管理、“远程精神治疗”和其他服务。远程医疗使用率增加的原因是费用，以及对于偏远地区(“服务不足”)来说，缺乏专业人员提供原本无法提供的服务。这项提议旨在开发一个计算机化的评估系统，能够以类似于考官与被评估对象面对面坐着的方式，对各种常用的认知测试工具以及行为-精神测量(BPM)进行远程、基于音频和视频的管理。拟议的远程检查计算机化评估系统(CARE)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疾病的患者进行彻底的神经心理或精神评估，这些疾病通常应用此类评估，包括创伤性脑损伤、中风、脑肿瘤、神经毒理损伤、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城市地区的医院、管理式医疗设施、团体诊所、疗养院、教养设施、地区卫生诊所和患者家中的临床评估单位。CARE将实施一种全新的方法，即远程考官查看全屏幕、特定于应用程序的图形用户界面，该图形用户界面提供屏幕控制，使考官能够：控制考试过程的速度，重复和补充计算机化的指令，立即对口头报告或公开行为进行实时评分，以及暂停或终止考试。因此，CARE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，CARE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，受试者由人类考官亲自陪同。这个前置系统的图形用户界面将被改装成一个高分辨率电视窗口，允许检查者和患者相互查看和交谈，建立高质量的“远程呈现”，这对于涉及主观印象或对公开行为的判断的测试或BPM的管理尤其重要。因此，CARE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，而且存在僵化的管理程序和多重技术缺陷，这大大限制了可以可靠地向受损个人实施的测试工具的范围。在第二阶段，主要目标是：1)开发一个具有集成外围设备和软件实用程序的应用程序优化、标准化、移动护理硬件平台(CHP)；以及2)比较伴随的计算机化测试与远程计算机化测试的并发效度、测试-重测可靠性和用户可接受性。CARE将是此类系统中的第一个，并可能立即在一系列医疗保健提供网络、研究环境和受控临床试验中获得商业应用。 公共卫生相关性：远程检查员计算机化评估系统(CARE)是一项独特和高度创新的技术，旨在促进以电视为基础的神经心理和精神病学评估服务，在目前由于地理或经济障碍限制提供这种服务的受过适当培训的专业人员的“服务不足”的地区。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)的个人，被监禁在惩教设施中的个人，以及诸如非门诊患者或疗养院居民等各种“回家”的个人。需要为这些患者提供原本无法获得的精神健康服务，这是当前项目希望解决的一个紧迫的差距。