Web System for Engaging Families & Doctors in Continuous Asthma Quality Improveme

描述(由申请人提供)：哮喘影响8%的美国儿童，是急诊室就诊、住院、缺课、痛苦和死亡的主要原因。它对低收入少数群体的影响不成比例。这项建议旨在克服实施国家哮喘指南的医疗保健提供障碍--临床医生未能提供基于指南的护理，以及当提供适当治疗时患者遵守。该项目将开发并测试创新的基于网络的决策支持系统(CHADIS)的有效性，以支持医生和患者在持续提高医生哮喘护理质量以及父母和孩子参与自己护理的并行进程中开展合作。CHADIS让父母完成访问前的问卷调查，这些问卷会触发患者对医生的特定决策支持，以便在访问中使用。患者将完成儿科哮喘控制与沟通仪器(PACCI)，这是一份哮喘症状问卷，最近由一名联合调查员通过CHADIS访问前和访问之间在线验证了一系列人口统计数据。在访问期间，医生与CHADIS决策支持部门的互动导致重新认证学分的文档和个性化家长教育的触发出现在一个称为记忆书/关怀门户的诱人网站上。患者的依从性是通过临床医生根据就诊前的症状和障碍数据提示进行的问题解决咨询来解决的。患者还可以在关怀门户中获得量身定制的默认消息和警报，远程教练也可以监控这些消息和警报。预计将在两次就诊之间监测哮喘症状，CHADIS使用多种形式的自动化通信(短信、电子邮件和电话)来提示完成PACCI。此外，鼓励家长通过多种形式的增援方式进行问卷调查，包括：记忆书、免费产品优惠券和“游戏化”，即娱乐视频和问答游戏，以进行个性化的患者教育。在第一阶段，该系统是通过专业和患者的反馈和试验建立的，并提交给医学专业委员会进行正式的QI MOC认证。在第二阶段，该系统被进一步改进，然后通过使用整群随机对照设计的大型干预研究来测试其在改善哮喘控制方面的有效性。第三阶段的产品将具有市场价值，因为它将改进和记录对质量改进、维持认证信用、有意义的使用、临床质量测量、按绩效付费和医疗之家的努力。

DESCRIPTION (provided by applicant): Asthma affects 8% of US children and is a leading cause of ED visits, hospitalization, missed school, suffering and death. It disproportionately affects low income minorities. This proposal seeks to overcome health care delivery barriers to implementation of national asthma guidelines - both clinician failures to provide guideline based care and patient adherence when appropriate treatments are offered. This project will develop and then test effectiveness of an innovative web-based decision support system (CHADIS) to support teaming doctors and patients in parallel processes of continuous quality improvement of asthma care for doctors and engagement of parents and children in their own care. CHADIS engages parents in completing pre-visit questionnaires, which trigger patient specific decision support for doctors for use in the visit. Patients will complete the Pediatric Asthma Control & Communication Instrument (PACCI), a questionnaire of asthma symptoms recently validated across a range of demographics by one of the co-investigators, online via CHADIS pre-visit and between visits. Doctor interaction with CHADIS decision support during the visit results in both documentation for recertification credit and triggering of individualized parent education to appear in an enticing website for each child called the Memory Book/Care Portal. Patient adherence is addressed through Problem Solving Counseling by the clinician prompted by the pre-visit data on symptoms and barriers. Patients also are provided tailored default messages and alerts in the Care Portal which can also be monitored by a remote coach. Monitoring of asthma symptoms between visits is expected and CHADIS uses multiple forms of automated communication (texting, email, and phone) to prompt completion of the PACCI. In addition, parents are encouraged to do questionnaires through multimodal reinforcements including: the Memory Book, coupons for free products and "gamification" i.e. entertaining videos and quiz games for individualized patient education. In Phase I the system is built with professional and patient feedback and piloting and presented to medical specialty boards for formal QI MOC certification. In Phase II the system is further refined and then tested for effectiveness in improving asthma control by a large intervention study using a cluster randomized control design. The Phase III product will have market value as it improves and documents care for Quality Improvement, Maintenance of Certification credit, meaningful use, clinical quality measurement, pay for performance and Medical Home efforts.