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

描述（由申请人提供）：在选定人群中进行的患者分诊研究发现，大量患者需要或多或少的急性护理水平，分诊护士和医生认为47%-58%的艾德就诊不合适。造成这一问题的原因是，在确定适当的护理水平方面，缺乏服务的可获得性和响应性。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，但缺乏补偿和护士时间的高成本阻止了电话分诊的广泛实施。网络分诊系统使用与电话分诊相同的协议，但患者可以通过网络回答问题，并通过基于网络的临床决策支持（CDS）系统获得建议，从而大大降低成本。虽然现有的网络分流系统的研究已经显示出希望，包括良好的一致性与护士的建议和高患者满意度，有必要衡量这种方法的安全性和成本节约，然后才能广泛部署。一项与查佩尔山的北卡罗来纳州大学校园卫生服务（CHS）合作对1,500份病历进行的回顾性分析发现，每年有可能节省30万美元。拟议项目的目标是实施，测试和验证安全性和成本节约，基于Web的CDS分诊系统。创新的新功能，以提高安全性和节省成本，包括与电子病历，病人门户网站和分诊护士的工作流程，并包括全面的质量管理技术，将被添加到目前的系统。将进行一项随机对照试验，使用CHS测量网络分诊与当前实践相比的安全性和成本节约。通过拟议的系统节省下来的费用可以通过降低费用或其他服务返还给学生。该项目的成功实现可能导致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。 公共卫生相关性：我们的网络分诊系统使用临床决策支持（CDS）来推荐患者适当的护理水平，紧急程度，甚至是关于网络自我护理选项的文章。该系统有可能大大改善初级和紧急护理的提供和管理，包括提高响应能力、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诊的安全性和成本节约，这仍然是在一般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.