ED Disability Diagnostic Tool: An HIT Feasibility Study

6.摘要 主要研究者：洛里A.波斯特博士耶鲁大学急诊医学系副教授 标题：艾德残疾诊断工具：HIT可行性研究 目的：通过推导， 验证并比较Rasch残疾诊断工具（RDDT）与现有的残疾测量（MOD） 研究设计：这项多方法研究包括推导Rasch残疾量表：I）使用 RDDT对残疾指标进行回顾性评分，验证RDDT，选择Rasch量表的子集 用作艾德随机临床试验的简要指标; II）Proximal，与残疾相关 以患者为导向的结果评估（卫生保健服务利用率和死亡率）。本研究将 比较诊断，以确定对患者的结果和成本的影响。 方法：一个专家小组将确定残疾诊断工具的内容，Rasch量表将 在回顾性阶段对现有医院记录中的残疾进行评分。首先，我们要找回 自电子数据开始以来对艾德患者进行的残疾评估（每天20-30例） 耶鲁纽黑文医院的收集系统（2005年4月）。其次，我们将在艾德记录中对残疾进行评分， 患者> 65岁，并根据评估检查患者的结果，治疗和转诊。第三、 我们将研究评估如何影响艾德患者导向的结果。回顾阶段 这项研究将使我们能够跟踪随后的耶鲁医院和艾德访问，治疗和健康结果。简要 在回顾性分析中开发的准确和精确的RDDT将用于前瞻性阶段， 在随机临床试验中与现有MOD进行比较。将招募600名患者， 将研究对象随机分配到MOD（对照）或RDDT（试验）组。 包括艾德患者、家属和患者健康护理提供者将被随访两个月。主 将量化患者结局、艾德访视、住院和死亡率以进行比较。我们将 估计可预防的艾德就诊和住院的数量，并提供采用 EDs中的RDDT。最后，RDDT将依靠卫生信息技术。本研究的探索性目的 将评估工作流程、节省的时间和成本、效率和可用性，以便在教育署使用。 对健康结果的潜在影响：我们预计，更好的残疾诊断工具将降低 死亡率，减少不必要的费用，可预防的艾德就诊和住院，以及更好的质量， 为急诊室的病人提供帮助。

6. ABSTRACT Principal Investigator: Lori A. Post, Ph.D. Associate Professor, Yale Dept of Emergency Medicine Title: ED Disability Diagnostic Tool: an HIT Feasibility Study Objective: To improve health patient oriented outcomes in Emergency Departments (ED) by deriving, validating, and comparing the Rasch Disability Diagnostic Tool (RDDT) to existing Measure of Disability (MOD) Research Design: This multi methodological study includes deriving a Rasch scale of disability: I) Using the RDDT to retrospectively score disability indicators, validating the RDDT, selecting a subset of the Rasch scale to be used as a brief measure for an ED randomized clinical trial; II) Prospectively, linking disability assessments to patient oriented outcomes (health care service utilization and mortality). This study will compare diagnoses to determine impact on patient outcomes and costs. Methodology: An expert panel will determine content for the disability diagnostic tool, Rasch scales will be created to score disability in existing hospital records in the retrospective phase. First, we will retrieve all disability assessments performed on ED patients (20-30 per day) since the inception of the electronic data collection system at Yale New Haven Hospital (April 2005). Second, we will score disability in ED records for patients > 65 years and examine patient outcomes, treatments and referrals based on the assessment. Third, we will examine how the assessment impacted ED patient oriented outcomes. The retrospective phase of this study will allow us to track subsequent Yale hospital and ED visits, treatments, and health outcomes. A brief accurate and precise RDDT, developed in the retrospective analysis will be used for the prospective phase to compare with the existing MOD in a randomized clinical trial. 600 patients will be recruited over the course of the study and randomly allocated into the MOD (control) or RDDT (test) arm. Consented study subjects, including ED patients, families, and patient health care providers will be followed for two months. The primary patient outcomes, ED visits, hospital admits, and mortality will be quantified for comparative purposes. We will estimate the number of preventable ED visits and hospitalizations and provide a cost benefit for adopting the RDDT in EDs. Finally, the RDDT will rely on health information technology. The exploratory aim of the study will assess work flow, time and cost savings, efficiency and usability for use in the ED. Potential Impact on Health Outcomes: We expect that a better disability diagnostic tool will lead to lower mortality, a reduction in unnecessary costs, preventable ED visits and hospitalizations, and a better quality of life for patients presenting to Emergency Departments.