IBDPROMISE: A Web-based Patient-centric Model to Improve Quality and Outcomes

IBDPROMISE：基于网络的以患者为中心的模型，用于提高质量和结果

• 批准号: 8635100
• 负责人: Ashish Atreja
• 金额: $ 17.7万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8635100
• 关键词: Address; Adoption; Adult; Affect; Blood Pressure; Caring; Clinical; Clinical Trials Design; Cohort Studies; Colonoscopy; Communities; Computer Literacy; Consent; Cost Savings; Crohn' s disease; Data; Decision Making; Demographic Impact; Devices; Diabetes Mellitus; Dimensions; Disease; Disease Management; Drops; Economics; Effectiveness; Electronic Health Record; Electronics; Emotional; Enrollment; Evaluation; Focus Groups; Future; Goals; Graph; Health; Health Care Reform; Hemoglobin; Home environment; Hospitals; Hypertension; Immunization; Inflammatory Bowel Diseases; Institution; Lead; Learning; Licensing; Measurement; Measures; Medical; Methods; Metric; Modeling; Monitor; Multi-Institutional Clinical Trial; Office Visits; Online Systems; Outcome; Participant; Patient Outcomes Assessments; Patients; Personal Satisfaction; Phenotype; Physicians; Provider; Quality Indicator; Quality of Care; Quality of life; Questionnaires; Randomized Controlled Trials; Recommendation; Recording of previous events; Report (document); Reporting; Resources; Risk; Self Management; Severities; Severity of illness; Site; Societies; Socioeconomic Status; Stratification; Structure; Surveys; Tablets; Time; Ulcerative Colitis; Work; arm; base; compliance behavior; cost; cost effective; cost effectiveness; design; disease phenotype; disorder control; health care quality; health care service utilization; improved; literacy; meetings; point of care; primary outcome; prospective; public health relevance; skills; social; tertiary care; trend; web-enabled

PROJECT SUMMARY Background: Measuring and improving healthcare quality is an important national challenge. The discussion about quality and disease management rarely happens during office visits when patients and providers have a unique opportunity to listen to each other and make collaborative decisions. Hypothesis: Encouraging patients to proactively measure and improve quality can bring remarkable efficiency, effectiveness and cost-savings to quality improvement efforts. Goal: To acquire skills to design and evaluate a patient-centric model, IBDPROMISE (IBD Patient Reported Outcomes and Medical IIlness Severity Evaluation), in which patients with inflammatory bowel disease (IBD) measure their quality of care metrics (such as colonoscopy surveillance) as well as quality of life in waiting rooms and at home; and physicians use this information at the point of care for quality improvement efforts. The specific aims of the project are: " AIM I. Define a set of comprehensive quality of care metrics (such as immunization, appropriate colonoscopy surveillance) for IBD patients from national recommendations. " AIM II. Measure longitudinally quality of care metrics and quality of life (QOL). " AIM III. Conduct a randomized controlled trial to determine the impact of IBDPROMISE in improving outcomes (quality of care, quality of life, patient adherence, disease control and resource utilization). Methods: All eligible adult patients arriving in Mount Sinai Hospital IBD center and a community site during study recruitment will be offered tablet-based questionnaire in waiting rooms and enrolled once consented. After a baseline period (at least six months), participants in the IBDPROMISE arm will be asked to report their quality of care metrics and QOL every month for 18 months. This will generate an electronic health card (detailing disease summary, quality metrics and a graph showing the trend of QOL and healthcare utilization over time). Patients and providers will use the health card, active decision support (a drop in scores) and passive decision support (quality dashboards and reminders) to improve the quality of care collaboratively. Outcome: The primary end-point of the study is the proportion of patients in each group (IBDPROMISE vs. control) who meet all eligible quality metrics at week 104. Secondary endpoints will be comparison of quality of life, disease control rates and utilization of healthcare resources between the two arms. Additional analysis will be done to determine the impact of demographics, socioeconomic status and computer literacy on IBDPROMISE adoption and improvement in outcomes. Future Direction: This project will help me acquire critical skills in self-management, quality improvement, design of clinical trials and analysis of quality of life data and cost effectiveness. In the future, IBDPROMISE and its point of care QI model within EHR, if proven successful, will be made available license-free to other academic institutions, and help me implement multi-site clinical trials and prospective cohort studies in IBD.

项目摘要 背景：衡量和提高医疗质量是一项重要的国家挑战。的讨论 关于质量和疾病管理很少发生在诊所访问时，病人和提供者有一个 这是一个独特的机会，可以倾听彼此的意见并做出合作决定。 假设：鼓励患者主动测量和改善质量可以带来显着的效率， 效率和成本节约，以提高质量的努力。 目标：获得设计和评估以患者为中心的模型IBDPROMISE（IBD患者报告 结果和医学疾病严重程度评价），其中炎症性肠病（IBD）患者 测量他们的护理质量指标（如结肠镜检查监测）以及等待中的生活质量 房间和家里;医生在护理点使用这些信息来提高质量。 该项目的具体目标是： “AIM I.定义一组全面的护理质量指标（如免疫接种、适当的 结肠镜检查监测）的IBD患者的国家建议。 “AIM II.纵向测量护理质量指标和生活质量（QOL）。 “AIM III.进行一项随机对照试验，以确定IBDPROMISE在改善 结果（护理质量、生活质量、患者依从性、疾病控制和资源利用）。 方法：所有符合条件的成年患者在治疗期间到达西奈山医院IBD中心和社区站点。 研究招募将在候诊室提供基于平板电脑的问卷，并在获得同意后入组。 基线期（至少6个月）后，将要求IBDPROMISE组的受试者报告其 护理质量指标和QOL，每月持续18个月。这将生成电子健康卡 （详细说明疾病总结、质量指标以及显示QOL和医疗保健利用趋势的图表 随着时间的推移）。患者和医疗服务提供者将使用健康卡、主动决策支持（分数下降）和 被动决策支持（质量仪表板和提醒），以协同提高护理质量。 结果：研究的主要终点是每组患者的比例（IBD PROMISE vs. 对照组），其在第104周满足所有合格的质量度量。次要终点将是 两组之间的寿命、疾病控制率和医疗资源利用率。额外分析 将完成，以确定人口统计，社会经济地位和计算机素养的影响， IBDPROMISE的采用和成果的改进。 未来方向：这个项目将帮助我获得自我管理，质量改进， 设计临床试验和分析生活质量数据和成本效益。在未来，IBDPROMISE 其在EHR中的护理点QI模型，如果被证明是成功的，将免费提供给其他 学术机构，并帮助我实施IBD的多中心临床试验和前瞻性队列研究。