Technology for Optimizing Population Care in a Resource-limited Environment

在资源有限的环境中优化人口护理的技术

• 批准号: 8080472
• 负责人: STEVEN J Atlas
• 金额: $ 34.12万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8080472
• 关键词: Technology; Optimizing; Population; Care; Resource

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.

描述（由申请人提供）：我们的医疗保健系统经常被视为过于昂贵，分散，效率低下，不安全。患者登记和信息技术（IT）可以促进改善初级保健环境中的医疗保健，将护理扩展到传统的一对一访问之外。然而，目前还不知道实施初级保健人口管理卫生信息技术系统的最有效和最高效的方法。我们建议测试的假设，集成电子健康记录数据的IT平台可以有效地利用独特的知识，临床医生对他们的病人，以提高护理。具体来说，我们将研究在一个新的信息平台，促进癌症预防之间的办公室访问中为给定的患者匹配“正确”的供应商的价值。这一假设将在我们基于初级保健实践的研究网络（PBRN）内进行的乳腺癌、宫颈癌、结直肠癌和前列腺癌预防性筛查的随机临床试验中进行测试。在针对逾期未进行筛查的合格患者的干预实践中，临床医生（医生和临床人群管理人员）将使用基于网络的工具来审查其患者列表，并根据患者的独特风险状况“一键”选择筛查决定。与对照患者相比，定制的外展，包括信件，共享决策辅助工具，实践人员或患者导航员联系，将通过更好地将外展与患者的需求联系起来，有效地提高筛查率。对于对照组，我们将定义一个标准的增强护理，模仿当前人口水平的提醒系统，并辅以自动化的使用。这将涉及一个集中的过程，向所有逾期未进行筛选的患者邮寄信件，而无需提供者审查。系统将自动跟踪已完成的检查，仅在筛选未在规定时间内完成时通知执业人员联系患者。对于逾期未交的患者，患者导航员将仅评估和联系高风险控制患者。具体目标1：设计、开发和实施一种新型癌症筛查干预计划，称为在资源有限的环境中优化人群护理的技术（TOP-CARE），有助于识别、个性化联系和后续跟踪逾期筛查的患者。具体目标二：在我们的PBRN内进行TOP-CARE计划的实践随机试验，评估其对合格患者癌症筛查率的影响。 具体目标3：在随机试验期间前瞻性收集有关成本、偏好以及临床和过程结局的数据，以告知随后的正式成本效益分析。这项研究是相关的全国性的努力，如以病人为中心的医疗之家，严格证明最有效和最高效的方式来实施新的基于IT的健康服务模式，以提供高质量的人口为基础的初级保健资源有限的医疗保健设置。

项目成果

Health IT-assisted population-based preventive cancer screening: a cost analysis.

卫生信息技术辅助的基于人群的预防性癌症筛查：成本分析。

• 发表时间: 2015
• 期刊: The American journal of managed care
• 作者: Levy,DouglasE;Munshi,ViditN;Ashburner,JeffreyM;Zai,AdrianH;Grant,RichardW;Atlas,StevenJ
• 通讯作者: Atlas,StevenJ

Applying operations research to optimize a novel population management system for cancer screening.

应用运筹学来优化用于癌症筛查的新型人口管理系统。

• DOI: 10.1136/amiajnl-2013-001681
• 发表时间: 2014
• 期刊: Journal of the American Medical Informatics Association : JAMIA
• 作者: Zai,AdrianH;Kim,Seokjin;Kamis,Arnold;Hung,Ken;Ronquillo,JeremiahG;Chueh,HenryC;Atlas,StevenJ
• 通讯作者: Atlas,StevenJ