A Mobile Personal Health Record for Behavioral Health Homes

描述（由申请人提供）：医疗保健质量差是严重精神疾病（SMI）患者医疗发病率过高和过早死亡的主要原因。为了解决这一问题，社区精神保健提供者越来越多地与安全网医疗提供者合作，发展行为保健之家和综合诊所，在这些诊所中，重度精神障碍患者接受协调的医疗和精神保健。然而，行为健康之家在跨组织整合电子医疗记录方面面临着后勤和隐私方面的挑战。这个应用程序建议开发和测试一个移动个人健康记录（mPHR）来克服这个问题，同时更充分地让患者参与到他们的医疗保健中来。mPHR将能够实时获取医疗和心理健康药物和实验室数据；帮助客户设定和保持健康和生活方式的目标；提供用药和预约提示和提醒；并通过与电子病历的异步通信，方便与供应商的通信。这项三阶段研究将开发、测试和传播mPHR。在第一阶段，我们将根据基于pc的PHR项目的经验和初步数据开发应用程序，并将其与行为健康之家的医疗和心理健康电子病历连接起来。在第二阶段，我们将在300名受试者中进行mPHR的随机试验，随机分配到mPHR或常规治疗。该研究将采用自适应设计，将在5个6个月的60名受试者中实施该应用程序。在每个队列之后，应用程序将根据可行性和可接受性发现、PHR应用程序的新研究和商业发展以及诊所和社区实践中常规护理的变化进行更新。分析将检查干预的总体效果，以及在研究队列中其益处是否有变化。研究结果将包括预防和心血管护理的质量；慢性疾病的患者激活和提供者管理；从社会和管理角度来看，服务使用包括药物依从性，错过预约，急诊科使用和护理成本。在干预的最后阶段，该应用程序将通过国家技术援助中心传播到全国各地的行为健康之家。拟议的研究将应用一种以前未在精神卫生环境中研究过的新技术，将在一种新的护理组织模式中进行，这种模式预计将在未来几年在社区精神卫生中得到广泛应用，并将使用一种创新的适应性设计，以确保干预措施在整个研究期间保持相关性和更新。包括精神卫生服务研究人员、信息技术和应用程序设计专家以及具有公共部门整合专业知识的政策制定者在内的多学科团队将有助于确保研究结果有助于改变精神卫生安全网设置中的护理服务。

DESCRIPTION (provided by applicant): Poor quality of medical care is a major contributor to excess medical morbidity and premature mortality in persons with serious mental illnesses (SMI). To address this problem, community mental health providers are increasingly partnering with safety net medical providers to develop behavioral health homes, integrated clinics in which persons with SMI receive coordinated medical and mental health care. However, behavioral health homes have faced logistical and privacy challenges in integrating electronic medical records across organizations. This application proposes to develop and test a mobile Personal Health Record (mPHR) to overcome this problem while more fully engaging patients in their health care. The mPHR will have the capability to access medical and mental health medication and lab data in real time; to help clients set and maintain health and lifestyle goals; to provide medication and appointment prompts and reminders; and to facilitate communication with providers via asynchronous communication with the EHRs. This three-phase study will develop, test, and disseminate the mPHR. During the first phase, we will develop the app building on experience and preliminary data from a PC-based PHR project, and link it to the medical and mental health EHR in a behavioral health home. During the second phase, we will conduct a randomized trial of the mPHR in 300 subjects randomized to the mPHR or usual care. The study will use an adaptive design, which will implement the app in five 6-month cohorts of 60 subjects. After each cohort, the app will be updated based on feasibility and acceptability findings, new research and commercial developments in PHR apps, and changes in usual care in the clinic and community practice. Analyses will examine overall effects of the intervention, and whether there is a change in its benefits across study cohorts. Study outcomes will include quality of preventive and cardiovascular care; patient activation and provider management of chronic illness; and service use including medication compliance, missed appointments, emergency department use, and costs of care from a societal and managerial perspective. During the final phase of the intervention, the app will be disseminated to behavioral health homes across the country through a national technical assistance center. The proposed study will apply a novel technology that has not previously been studied in mental health settings, will be conducted in a new organizational model of care that is anticipated to become widespread in community mental health in the coming years, and will use an innovative adaptive design that will ensure that the intervention remains relevant and updated throughout the study period. A multidisciplinary team including mental health services researchers, experts in information technology and app design, and policymakers with expertise in public sector integration will help ensure that the study results will help transform care delivery in mental health safety net settings.