Quality Improvement and Practice Based Research in Neurology Using the EMR

 描述（由申请人提供）：拟议研究的目标是使用电子病历（EMR）推进神经病学的质量改进和实践研究。美国神经病学学会（AAN）已经出版了基于证据的指南，质量改进措施和几种神经系统疾病的资源。然而，农业应用网的准则和措施尚未得到例行执行，基准数据也缺乏。有几个EMR工具可用于根据最佳实践标准化神经科门诊访视，当神经系统护理偏离AAN指南时提供警报，捕获关于遵守AAN或其他质量参数的数据，测量遵守指南对结局的影响，或共享纵向数据并比较神经系统实践中的护理有效性。NorthShore University HealthSystem（NorthShore）的神经病学系已内置于其商业EMR“Epic”结构化临床文档支持（SCDS）和临床决策支持（CDS）工具中，这些工具可标准化护理，编写进度记录，并在每次办公室访问时捕获多达1，000个离散和级联的神经学数据字段。然而，这些EMR工具还没有被传播用于其他神经病学实践或数据共享，目前不支持临床试验。使用EMR的实用性试验将能够在护理点进行治疗比较。为了解决神经病学质量改进和实践研究的差距，我们向医疗保健研究和质量机构（AHRQ）提出了一个项目，其具体目标是：1）创建神经病学实践研究网络（NPBRN）。NorthShore站点将与其他七个也使用Epic EMR平台的神经科（共八个站点）共享10种常见神经系统疾病（脑肿瘤、癫痫、偏头痛、轻度认知障碍、轻度创伤性脑损伤、多发性硬化症、神经病、帕金森病、不宁腿综合征和中风）的SCDS和CDS工具。2)在NorthShore使用EMR进行10种常见神经系统疾病的实用试验。我们将证明基于亚组的适应性治疗分配、电子同意和使用EMR在护理点采集结局数据的可行性。我们将确定最有效的治疗常见的神经系统疾病，并寻求复制的NPBRN。我们的目标是创新的，因为我们将使用EMR来硬连线神经病学的质量和结果研究。我们将通过使用基于亚组的适应性设计进行务实的试验，比较常见神经系统疾病的现有治疗方法的有效性，在护理点进行个性化治疗。我们的目标是重要的，因为我们正在研究几种神经系统疾病，这是全球医疗保健负担的主要原因。我们将创建一个全国性的实践网络，通过加速实施以患者为中心的神经病学成果研究，使用EMR和证据，使医疗保健更安全，提高医疗保健效率，从而提高医疗保健质量。

 DESCRIPTION (provided by applicant): The goals of the proposed research are to advance quality improvement and practice based research in Neurology using the electronic medical record (EMR). The American Academy of Neurology (AAN) has published evidence-based guidelines, quality improvement measures, and resources for several neurological disorders. However, the AAN guidelines and measures have not been implemented routinely and benchmark data are lacking. There are few EMR tools available to standardize neurology office visits according to Best Practices, to provide alerts when neurological care is deviating from AAN guidelines, to capture data regarding adherence to AAN or other quality parameters, to measure the effects of compliance with guidelines on outcomes, or to share longitudinal data and to compare effectiveness of care across neurological practices. The Department of Neurology at NorthShore University HealthSystem (NorthShore) has built into its commercial EMR "Epic" structured clinical documentation support (SCDS) and clinical decision support (CDS) tools that standardize care, write progress notes, and capture up to 1,000 discreet and cascading fields of neurological data per office visit. However, these EMR tools have not been disseminated for use by other Neurology practices or for data sharing, and presently do not support clinical trials. Pragmatic trials using EMRs would enable comparisons of treatments at the point of care. To address gaps in quality improvement and practice based research in Neurology, we are proposing to the Agency for Healthcare Research and Quality (AHRQ) a project with the specific aims: 1) To create a Neurology Practice Based Research Network (NPBRN). The NorthShore site will share SCDS and CDS tools for 10 common neurological disorders (brain tumors, epilepsy, migraine, mild cognitive impairment, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson's disease, restless legs syndrome, and stroke) with seven other Department of Neurology that also use the Epic EMR platform (eight sites total). 2) To conduct at NorthShore pragmatic trials using the EMR for 10 common neurological disorders. We will demonstrate the feasibility of subgroup based adaptive assignment of treatments, electronic consenting, and outcomes data capture at the point of care using the EMR. We will identify the most effective treatments for common neurological disorders and seek replication by the NPBRN. Our aims are innovative because we will use the EMR to hardwire quality and outcomes research in Neurology. We will individualize medicine at the point of care by conducting pragmatic trials using subgroup based adaptive designs, comparing the effectiveness of available treatments for common neurological disorders. Our aims are significant because we are studying several neurological disorders, a leading cause of healthcare burden worldwide. We will create a national practice based network to improve health care quality by accelerating implementation of patient-centered outcomes research in Neurology using the EMR, and evidence to make health care safer and to improve health care efficiency.