Integrated Online Assessment and Intervention Targeting Health Disparities

针对健康差异的综合在线评估和干预

• 批准号: 8077099
• 负责人: Andrew H. Soll
• 金额: $ 20万
• 依托单位: CPM SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-25 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8077099
• 关键词: Abbreviations; Address; Administrator; Algorithms; Attention; Caring; Case Manager; Clinic; Clinical; Cognitive; Collection; Communication; Communication Barriers; Computers; Continuity of Patient Care; Data; Data Collection; Diagnosis; Disadvantaged; Documentation; Early identification; Economics; Education; Educational process of instructing; Ensure; Ethnic Origin; Evaluation; Feedback; Foundations; Funding; Goals; Hand; Health; Health behavior change; Healthcare; Home environment; Income; Individual; Internet; Intervention; Interview; Knowledge; Length; Logic; Mental Depression; Methodology; Methods; Minority; Nurse Practitioners; Online Systems; Outcome; Pathway interactions; Patient Care; Patient Self-Report; Patient-Centered Care; Patients; Pattern; Performance; Phase; Physician Assistants; Physicians; Policies; Population; Post-Traumatic Stress Disorders; Preventive; Primary Health Care; Psychosocial Factor; Psychosocial Influences; Quality of life; Race; Recording of previous events; Reporter; Reporting; Research Infrastructure; Research Personnel; Research Support; Resistance; Resource Sharing; Resources; Review Literature; Risk; Risk Assessment; Self Assessment; Site; Small Business Innovation Research Grant; Social support; Solutions; Stress; Structure; Substance abuse problem; Symptoms; System; Technology; Testing; Time; Training; Training Support; Transcend; Trauma; Triage; United States National Institutes of Health; Update; Work; Workload; alcohol misuse; behavioral health; biopsychosocial; brief intervention; burden of illness; care delivery; cost; cost effective; cost effectiveness; design; disability; health care quality; health disparity; improved; meetings; operation; primary care setting; psychosocial; residence; routine care; skills; socioeconomics; stem; stress management; stressor; success; telehealth; touchscreen; treatment as usual; wasting; willingness

DESCRIPTION (provided by applicant): Socioeconomic and other factors such as race, ethnicity, income, education, and place of residence are associated with reduced access to and poorer quality healthcare. Clinicians serving disadvantaged populations are often overloaded, and have little chance to gather a comprehensive biomedical and psychosocial (biopsychosocial, BPS) evaluation of patients. This situation is unfortunate because many physical symptoms are medically unexplained, reflecting a pattern of high symptom reporting or underlying psychosocial issues, such as depression, trauma, or poorly-tolerated stress. These BPS factors are particularly problematic for patients from disadvantaged populations. Lastly, severe, medically unexplained symptoms, psychosocial issues, and poor quality of life (QOL) occur together in a subset of at-risk individuals (ARI), which comprises about 20% of typical clinic populations. ARI are at risk for poor outcomes and high costs from inappropriate care, a problem that is compounded in disadvantaged and minority populations where access to primary care is limited and urgent care is more prevalent than preventive care. SOLUTION: Our objective is to deploy a clinical methodology and infrastructure to ensure delivery of patient-centered care to minority and disadvantaged patients. Our work builds on an online, patient self-assessment system called CarePrep, now operational in clinic. CarePrep allows patients to easily enter and track BPS and QOL data over the Internet from home or clinic. However, just handing a diagnosis of depression, for example, to a clinician does not change outcomes. Therefore, we will also deploy an integrated intervention to support BPS care. APPROACH: 1) We will adapt, enhance cultural sensitivity, deploy, refine, and initially validate CarePrep in a primary care setting. Our goals are to meet the needs of patients and clinicians for enhancing communication and patient- centered care, ensuring that BPS issues are uncovered. Patients will be asked to do CarePrep before clinic. We will assess validity, feasibility, and CarePrep's ability to accurately identify patients who warrant extra attention (ARI) by findings such as severe symptoms, psychosocial issues, impaired QOL, or substance abuse. 2) We will analyze and develop a plan for supporting culturally competent, BPS care using some combination of automated CarePrep functionality, training and supporting care managers or existing clinic staff in delivering simple, brief BPS interventions, and telehealth support. IMPACT stems from 1) creating a system that generates sufficient value to patients, clinicians, and administrators to warrant routine use; 2) creating a streamlined, branching assessment that minimizes redundancy and maximizes relevance, thereby supporting collection of the full spectrum of relevant data and delivery of context-relevant education and guidance; 3) using this technology and clinical methodology to transcend barriers to care for minorities and disadvantaged populations, and 4) identifying, characterizing, and targeting care to the patients with the greatest need and highest utilization within such populations, thereby facilitating cost-effective use of limited healthcare dollars. PUBLIC HEALTH RELEVANCE: This work adapts an online, patient self-assessment system now in operation in clinic to support delivery of patient-centered care for minority and disadvantaged patients. We focus on helping clinicians care for patients with multiple, severe physical symptoms, psychosocial, and health behavioral issues that interfere with their quality of life and ability to function, because these patients now have the poorest outcomes and consume a disproportionate share of resources. These outcomes are likely to be worse in disadvantaged and minority populations where access to primary care is limited and urgent care more prevalent than preventive care. Our online system gathers a comprehensive assessment and presents the data so that clinicians can rapidly identify the most important issues. However, simply delivering this information is not enough; we also propose to support care by a combination of the online system offloading clinician tasks, training and supporting care managers or clinicians to help in assessment and treatment, and delivering telehealth support where needed.

描述（由申请人提供）：社会经济和其他因素，如种族、民族、收入、教育和居住地，与获得医疗保健的机会减少和质量较差有关。为弱势群体服务的临床医生常常超负荷工作，几乎没有机会收集患者的全面生物医学和心理社会（生物心理社会，BPS）评估。这种情况是不幸的，因为许多身体症状在医学上无法解释，反映了严重症状报告的模式或潜在的社会心理问题，例如抑郁、创伤或难以忍受的压力。这些 BPS 因素对于来自弱势群体的患者来说尤其成问题。最后，严重的、医学上无法解释的症状、社会心理问题和生活质量差 (QOL) 共同出现在高危人群 (ARI) 中，该人群约占典型诊所人群的 20%。急性呼吸道感染面临因护理不当而造成不良后果和高昂费用的风险，这一问题在弱势群体和少数族裔群体中更为复杂，因为他们获得初级保健的机会有限，而且紧急护理比预防性护理更为普遍。解决方案：我们的目标是部署临床方法和基础设施，以确保为少数族裔和弱势患者提供以患者为中心的护理。我们的工作建立在一个名为 CarePrep 的在线患者自我评估系统的基础上，该系统现已在临床上运行。 CarePrep 允许患者在家中或诊所通过互联网轻松输入和跟踪 BPS 和 QOL 数据。然而，仅仅将抑郁症的诊断交给临床医生并不会改变结果。因此，我们还将部署综合干预措施来支持 BPS 护理。方法：1) 我们将在初级保健环境中适应、增强文化敏感性、部署、完善和初步验证 CarePrep。我们的目标是满足患者和临床医生加强沟通和以患者为中心的护理的需求，确保 BPS 问题被发现。患者将被要求在就诊前进行 CarePrep。我们将评估有效性、可行性以及 CarePrep 通过严重症状、心理社会问题、生活质量受损或药物滥用等结果准确识别需要额外关注 (ARI) 的患者的能力。 2) 我们将分析和制定一项计划，使用自动化 CarePrep 功能、培训和支持护理经理或现有诊所工作人员提供简单、简短的 BPS 干预措施和远程医疗支持的某种组合，来支持具有文化能力的 BPS 护理。 IMPACT 源于 1) 创建一个为患者、临床医生和管理人员产生足够价值以保证日常使用的系统； 2) 创建精简的分支评估，最大限度地减少冗余并最大限度地提高相关性，从而支持收集全方位的相关数据并提供与背景相关的教育和指导； 3) 使用这种技术和临床方法来克服照顾少数族裔和弱势群体的障碍，以及 4) 识别、描述和瞄准这些人群中最需要和最高利用率的患者的护理，从而促进有限医疗资金的成本效益使用。 公共卫生相关性：这项工作采用了目前在诊所运行的在线患者自我评估系统，以支持为少数族裔和弱势患者提供以患者为中心的护理。我们专注于帮助临床医生护理患有多种严重身体症状、心理社会和健康行为问题的患者，这些问题会影响他们的生活质量和功能，因为这些患者现在的结果最差，并且消耗了不成比例的资源。在弱势群体和少数群体中，这些结果可能会更糟，因为他们获得初级保健的机会有限，而且紧急护理比预防性护理更为普遍。我们的在线系统收集全面的评估并呈现数据，以便临床医生能够快速识别最重要的问题。然而，仅仅提供这些信息是不够的。我们还建议通过在线系统减轻临床医生的任务、培训和支持护理管理者或临床医生以帮助评估和治疗以及在需要时提供远程医疗支持来支持护理。