Web Triage as a Critical Patient Portal Function: RCT for Safety and Cost-Savings

描述(由申请人提供)：在选定人群中对患者分诊的研究发现，相当多的患者需要更多或更轻的急救级别的护理，47%-58%的急诊就诊被分流护士和医生认为不合适。造成这一问题的原因之一是缺乏服务的可及性和响应性，无法确定适当的护理水平。在一项研究中，62%的患者在去急诊室之前无法联系到他们的初级保健医生。电话分诊已被提出作为一种解决方案，但缺乏报销和高昂的护理时间成本阻碍了电话分诊的广泛实施。Web分诊系统使用与电话分诊相同的协议，但患者可以通过Web回答问题并通过基于Web的临床决策支持(CDS)系统接收建议，从而大大降低成本。尽管现有的关于网络分诊系统的研究已经显示出前景，包括与护士建议的良好一致性和患者的高满意度，但在广泛部署之前，需要衡量这种方法的安全性和成本节约。北卡罗来纳大学教堂山分校与校园卫生服务(CHS)合作，对1500名患者的病历进行了回顾分析，发现每年有可能节省30万美元。拟议项目的目标是实施、测试和验证基于网络的CDS分诊系统的安全性和成本节约。目前的系统将增加创新的新功能，以提高安全性和节省成本，包括与电子病历、患者门户和分诊护士工作流程的集成，并包括全面的质量管理技术。将进行一项随机对照试验，由社区卫生服务衡量网络分类与当前做法的安全性和成本节约。拟议系统所节省的费用可以通过降低学费或其他服务返还给学生。该项目的成功实现可能会带来一个具有巨大商业潜力的CDS系统--为保险公司节省数百万美元，并为消费者提供更好的患者安全、更适当的护理和更低的成本。 与公共健康相关：我们的网络分诊系统使用临床决策支持(CDS)来向患者推荐适当级别的护理、紧急情况，甚至在网络上推荐关于自我护理选项的文章。这一系统有可能对初级和紧急护理的提供和管理作出重大改进，包括提高反应能力、患者安全、确定成本较低的护理替代方案以及降低消费者的保险费。我们计划进行一项随机对照试验(RCT)，以更好地了解网络分类的安全性和成本节约，这仍然是在普通社区采用这项技术的两个障碍。

DESCRIPTION (provided by applicant): Studies of patient triage in selected populations found significant numbers of patients needing either a more or a less acute level of care, and that 47%-58% of ED visits were considered inappropriate by triage nurses and physicians. Contributing to this problem is lack of accessibility and responsiveness of services to determine the appropriate level of care. In one study, 62% of patients could not reach their primary care physician before going to the ER. Telephone triage has been proposed as one solution, but lack of reimbursement and the high cost of nurse time have prevented telephone triage from widespread implementation. Web triage systems use the same protocols as telephone triage, but patients can answer the questions over the web and receive recommendations through a web-based Clinical Decision Support (CDS) system, greatly reducing costs. Though existing research on web triage systems have shown promise, including good congruence with nurse recommendations and high patient satisfaction, there is a need to measure the safety and cost-savings of this approach before it can be widely deployed. A retrospective analysis of 1,500 patient records in partnership with Campus Health Services (CHS) at the University of North Carolina at Chapel Hill has found the potential to save $300,000 per year. The goals of the proposed project are to implement, test, and verify safety and cost-savings, of a web-based CDS triage system. Innovative, new features to improve safety and cost savings, including integration with electronic medical records, the Patient Portal, and the triage nurse's workflow, and include comprehensive quality management techniques, will be added to the current system. A randomized controlled trial with CHS measuring safety and cost savings of web triage versus current practice will be conducted. The savings accrued with the proposed system could be returned to students through reduced fees or other services. Successful achievement of this project could lead to a CDS system with large commercial potential -- saving millions of dollars for insurance companies, and providing improved patient safety, more appropriate care, and lower costs for consumers. PUBLIC HEALTH RELEVANCE: Our web triage system uses Clinical Decision Support (CDS) to recommend patients an appropriate level of care, urgency, and even articles on self-care options over the web. This system has the potential to make significant improvements to the delivery and management of primary and emergency care, including improved responsiveness, patient safety, identifying lower cost care alternatives, and reducing insurance premiums for consumers. We plan to run a randomized controlled trial (RCT) to better understand the safety and cost savings of web triage, which remain as two barriers to adoption of this technology in the general community.