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。患者登记和信息技术（IT）可以促进在初级保健环境中改善卫生保健的努力，这些技术将护理扩展到传统的一对一就诊之外。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有效的方法。我们建议测试这样一个假设，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对患者的独特知识来加强护理。具体来说，我们将研究在一个新的信息平台中为特定患者匹配“正确”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）中进行预防性乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查的随机临床试验。在对逾期筛查的合格患者的干预实践中，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名单，并根据患者独特的风险概况“一键”选择筛查决策。量身定制的外展，包括信函、共享决策辅助工具、执业人员或患者导航员联系，与对照患者相比，通过更好地将外展与患者需求联系起来，将有效提高筛查率。对于对照组，我们将定义一个增强护理标准，该标准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，向所有在没有医生审查的情况下逾期筛查的患者邮寄信件。系统将自动跟踪已完成的测试，如果筛查未在规定时间内完成，则仅通知执业人员联系患者。对于逾期患者，患者导航员将只评估和联系高风险控制患者。以下具体目标将被测试：具体目标1：设计、开发和实施一项新的癌症筛查干预计划，称为资源有限环境下优化人群护理技术（TOP-CARE），该计划有助于识别、个性化联系以及对逾期筛查患者的后续跟踪。具体目标2：在我们的PBRN中开展TOP-CARE项目的实践随机试验，评估其对符合条件的患者癌症筛查率的影响。

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.