Technology for Optimizing Population Care in a Resource-limited Environment

描述(由申请人提供)：我们的医疗保健系统经常被认为过于昂贵、分散、低效和不安全。通过病人登记和信息技术(IT)将护理扩展到传统的一对一就诊之外，可以促进改善初级保健环境中的卫生保健的努力。然而，目前还不知道为初级保健人口管理实施卫生信息技术系统的最有效和最高效的方法。我们建议测试这一假设，即集成电子健康记录数据的IT平台可以有效地利用临床医生拥有的关于患者的独特知识来加强护理。具体地说，我们将检查在一个新的信息学平台内为给定的患者匹配“正确的”提供者的价值，该平台有助于在办公室就诊之间预防癌症。这一假设将在我们基于初级保健实践的研究网络(PBRN)内的预防乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查的随机临床试验中得到验证。在针对过期筛查的符合条件的患者的干预实践中，临床医生(医生和临床人口管理人员)将使用基于网络的工具来审查他们的患者列表，并根据患者独特的风险概况通过“一键”选择筛查决定。与对照患者相比，量身定做的外展服务，包括信件、共享决策辅助工具、执业人员或患者导航员联系，将更好地将外展服务与患者的需求联系起来，从而有效地提高筛查率。对于对照组，我们将定义一个增强护理的标准，该标准模仿当前的人口水平的提醒系统，并使用自动化。这将涉及一个集中的过程，在没有提供者审查的情况下向所有似乎逾期进行筛查的患者邮寄信件。该系统将自动跟踪完成的测试，并仅在指定时间内未完成筛查时通知执业人员联系患者。对于逾期的患者，患者导航员将只评估和联系高风险控制患者。将测试以下具体目标：具体目标1：设计、开发和实施一种新的癌症筛查干预计划，名为在资源有限的环境中优化人口护理的技术(TOP-CARE)，该计划有助于识别、个性化接触和后续跟踪逾期筛查的患者。具体目标2：在我们的PBRN内对顶级护理计划进行一项实践随机试验，评估其对符合条件的患者的癌症筛查率的影响。 具体目标3：在随机试验期间前瞻性地收集有关费用、偏好、临床和过程结果的数据，以便为后续的正式成本效益分析提供信息。这项研究与全国性的努力相关，例如以患者为中心的医疗之家，以严格展示实施基于IT的新型医疗服务模式的最有效和最高效的方法，以在资源有限的医疗保健环境中提供高质量的以人口为基础的初级保健。

DESCRIPTION (provided by applicant): Our health care system is frequently seen as too costly, fragmented, inefficient, and unsafe. Efforts to improve health care in the primary care setting can be facilitated by patient registries and information technology (IT) that expand care beyond traditional one-on-one visits. However, the most effective and efficient approaches to implementing health IT systems for primary care population management are not currently known. We propose to test the hypothesis that an IT platform that integrates electronic health record data can efficiently leverage the unique knowledge clinicians have about their patients to enhance care. Specifically, we will examine the value of matching the "right" provider for a given patient within a novel informatics platform that facilitates cancer prevention between office visits. This hypothesis will be tested in a randomized clinical trial of preventive breast, cervical, colorectal and prostate cancer screening within our primary care practice based research network (PBRN). In intervention practices for eligible patients overdue for screening, clinicians (physicians and clinical population managers) will use a web-based tool to review their patient list, and with "one click" select a screening decision based upon the patient's unique risk profile. Tailored outreach, including letters, shared decision making aids, practice personnel or patient navigator contact, will efficiently improve screening rates by better linking outreach to the patient's needs compared to control patients. For the control group, we will define a standard of augmented care that mimics current population-level reminder systems supplemented by the use of automation. This will involve a centralized process to mail letters to all patients who appear overdue for screening without provider review. The system will automatically track completed tests and only notify practice personnel to contact patients if screening is not completed within a specified time. For patients remaining overdue, patient navigators will evaluate and contact only high risk control patients. The following Specific Aims will be tested: Specific Aim 1: To design, develop, and implement a novel cancer screening intervention program called Technology for Optimizing Population Care in A Resource-limited Environment (TOP-CARE) that facilitates the identification, individualized contact, and subsequent tracking of patients overdue for screening. Specific Aim 2: To conduct a practice randomized trial of the TOP-CARE program within our PBRN assessing its impact on cancer screening rates in eligible patients. Specific Aim 3: To prospectively collect data during the randomized trial about the costs, preferences, and clinical and process outcomes to inform a subsequent formal cost-benefit analysis. This research is relevant to nationwide efforts, such as the patient-centered medical home, to rigorously demonstrate the most effective and efficient ways to implement novel IT-based health delivery models to provide high quality population-based primary care within resource-limited health care settings.