Automated Youth-To-Adult Transition Planning Using Health Information Technology

这项提案寻求利用卫生信息技术改善过渡时期的护理。过渡的过程 从儿科到成人服务提供者是初级保健和次级专科的普遍需求。小事一桩 已经在儿科胃肠病学领域进行了专门的研究，以满足慢性胃病患者的需求 胃肠道疾病。我们建议使用现有的计算机化临床决策支持系统(CHICA -通过计算机自动化系统改善儿童健康)，试行从青年到成人的过渡 一个大型初级保健网络中的模块。要实现这一点，就必须将“六大核心要素”自动化 由国家医疗保健过渡中心提出的“医疗保健过渡的指导方针”。这些核心要素包括 (1)与家庭分享过渡政策，(2)提供过渡跟踪和监测，(3)评估 使用标准化工具(Traq-过渡准备情况评估问卷)的过渡准备情况， (4)通过反复准备所有必要的过渡技能和文件来进行过渡规划，(5) 完成护理转移本身，以及(6)评估转移完成情况。这些核心元素中的每个 将结合使用面向患者(平板电脑)和面向提供商(WebForms 电子病历)。一旦编写并测试了这些软件规则，它们将在 现有的初级保健决策支持系统。我们将反复评估以下目标：(1)每个患者的 适合其年龄的过渡准备情况，以及(2)提供者和患者对过渡的满意度 进程。这些结果将在事后设计中进行比较，数据将在前6个月收集 在中国国际协力事业团实施过渡模块前几个月。在这6个月期间之后， 将打开过渡模块，并对这些结果进行重复评估。如果这次试飞是 成功后，我们将准备在类似的系统(CHICA-GI)中启动此模块，该系统将在 儿科胃肠病门诊。一旦该系统启用了转换模块，我们将能够测试它是否 为胃肠病专科患者实现类似的目标，包括针对特定疾病的过渡 目标，在未来的R21和R01应用中。总体而言，拟议的R03代表了一系列循序渐进的活动 这将在我的K奖申请中奠定的基础上展开，关于探索 可以通过使用计算机化的方法来改进对指南或推荐护理实践的遵守 决策支持系统，从而最终影响健康和以患者为中心的结果。考虑到我的过去 实施初级保健CDSS(K-奖励目标1)的经验和我目前实施的经验 胃肠病专用CDSS(K-大奖目标2和3)，R03与我目前的活动完美契合。 这一奖励将允许在现有系统中增加另一个层面，包括初级保健和 胃肠病学方面。

This proposal seeks to improve transition care using health information technology. The process of transition from a pediatric to adult provider is a universal need across both primary care and subspecialties. Little work has been done specifically within pediatric gastroenterology to address the needs of patients with chronic gastrointestinal disease. We propose to use an existing computerized clinical decision support system (CHICA – the Child Health Improvement through Computer Automation system) to pilot a youth-to-adult Transition module within a large primary care network. This will be accomplished by automating the “Six Core Elements of Healthcare Transition” set forth by the National Health Care Transition Center. These core elements consist of: (1) sharing the transition policy with families, (2) providing transition tracking and monitoring, (3) assessing transition readiness using a standardized tool (the TRAQ – Transition Readiness Assessment Questionnaire), (4) transition planning through iterative preparation of all necessary transition skills and documents, (5) accomplishing the transfer of care itself, and (6) assessing transfer completion. Each of these core elements will be accomplished using a combination of patient-facing (tablets) and provider-facing (webforms alongside the electronic medical record). Once these software rules are written and tested, they will be piloted in the existing primary care decision support system. We will iteratively assess the following goals: (1) each patient’s transition readiness as appropriate for their age, and (2) provider and patient satisfaction with the transition process. These outcomes will be compared in a pre-post design, data will be collected during the first 6 months prior to the Transition module being implemented in CHICA. Following this 6-month period, the Transition module will be turned on, and a repeat assessment made of these outcomes. If this pilot test is successful, we will then be ready to launch this module in a similar system (CHICA-GI) that will be live in the pediatric gastroenterology clinic. Once this system has a transition module active, we will be able to test if it accomplishes similar goals for gastroenterology subspecialty patients, including disease-specific transition goals, in future R21 and R01 applications. Overall, the proposed R03 represents a stepwise set of activities which will expand upon the groundwork laid in my K-award application regarding the exploration of whether adherence to guidelines or recommended care practices can be improved through the use of computerized decision support systems, and thereby ultimately impact health and patient-centered outcomes. Given my past experience of implementing a primary care CDSS (K-award Aim 1) and my current experience implementing a gastroenterology-specific CDSS (K-award Aims 2 and 3), the R03 fits seamlessly with my current activities. This award will allow for another dimension to be added to the existing system on both the primary care and gastroenterology side.