Using Health Risk Appraisal to Prioritize Primary Care Interventions

描述（由申请人提供）：目前循证医学护理的一个趋势是根据临床试验、流行病学研究和专家意见的结果制定临床实践指南，然后将其应用于患者的护理，同时考虑到患者的偏好和背景问题。这种方法可能最适合有一种或几种慢性健康问题的患者。然而，面对多种共存的慢性疾病，它似乎崩溃了。识别、评估和管理多种健康状况所需的时间可能会使为单一问题设计的系统不堪重负。据估计，仅执行美国预防服务工作队准则一项，每个初级保健临床医生每天就需要花费7个多小时。因此，有必要分清轻重缓急。本K08申请概述了一个五年计划，以支持已经通过开发、实施和研究初级保健环境中卫生信息技术资源的使用，以新方式为“临床研究企业再造”做出贡献的候选人。候选人是一名研究助理教授，拥有超过10年的生物医学、临床和实践研究经验，并得到了他所在学术部门的大力支持。他也是全国公认的卫生信息技术资源开发人员。职业发展计划提供一系列精心挑选的培训和指导经验，包括博士级研究课程，指导研究导致合作研究和出版物，以及专业网络，这将大大有助于候选人的专业发展。他提出的研究计划“使用健康风险评估来优先考虑初级保健干预措施”有三个具体目标：1)对现有文献进行系统回顾，以完善临床综合健康风险评估（HRA）实施的新实施模型，帮助临床医生优先考虑循证干预措施；2)在基于初级保健实践的研究网络中完善和试点测试综合HRA技术，以确定该工具实施的可行性和有效性；3)进行一项随机临床试验，以检验这种综合HRA方法对重要患者结局的影响，包括估计预期寿命、以患者为中心的护理以及初级保健实践中的提供者和患者满意度。

DESCRIPTION (provided by the applicant): A current trend in evidence-based medical care is to develop clinical practice guidelines based upon the findings from clinical trials, epidemiologic studies and expert opinion, and then to apply them to the care of patients, taking into account patient preferences and contextual issues. This approach probably works best for the management of patients with one, or only a few, chronic health problems. However, it appears to break down in the face of multiple coexisting chronic conditions. The time required to identify, evaluate, and manage multiple health conditions can overwhelm a system designed for single problems. It has been estimated that implementation of United States Preventive Services Task Force Guidelines alone would take over seven hours a day per primary care clinician. It is therefore necessary to prioritize. This K08 application outlines a five-year plan to support a candidate who is already contributing to "Reengineering the Clinical Research Enterprise" in new ways by developing, implementing, and studying the use of health information technology resources in primary care settings. The candidate is an Assistant Professor of Research with over 10 years of combined biomedical, clinical, and practice-based research experience and strong support from his academic department. He is also a nationally recognized developer of health information technology resources. The career development plan provides a sequence of carefully selected training and mentored experiences, including doctoral-level research coursework, mentored research leading to collaborative studies and publications, and professional networking, which will substantially contribute to the candidate's professional development. His proposed research program, "Using Health Risk Appraisal to Prioritize Primary Care Interventions", has three specific aims: 1) Conduct a systematic review of the existing literature in order to refine a novel implementation model of a clinically integrated Health Risk Appraisal (HRA) implementation that will help clinicians prioritize evidence-based interventions; 2) Refine and pilot test the integrated HRA technology within a primary care practice-based research network to determine the feasibility of implementation and the efficacy of the instrument; 3) Conduct a randomized clinical trial to examine the impact of this integrated HRA approach on important patient outcomes, including estimated life expectancy, patient centeredness of care, and provider and patient satisfaction in primary care practices.