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Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and Liver Cancer (CLOVER)

加强电子卫生系统以减轻结肠癌、肺癌、肥胖、疫苗可预防疾病和肝癌的负担 (CLOVER)

基本信息

批准号：
10238837
负责人：
Eric W Chak
金额：
$ 29.38万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-15 至 2022-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY With the goal of improving medical care and reducing health disparities for the aging American population, the University of California, Davis (UCD) and University of California, Irvine (UCI) have collaborated to propose “Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and LivER Cancer” (“CLOVER”). The overall goal of CLOVER is to develop, deliver, and disseminate electronic health systems (EHR)-based interventions that will improve the well-being of older adults through increasing the adherence to selected US Preventive Services Task Force (USPSTF) Grade A and Grade B recommendations and Centers for Disease Control and Prevention (CDC) vaccination recommendations. We will accomplish this goal through pilot (R61) and clinical trial (R33) phases using the following Specific Aims: Aim #1 (R61): Conduct Stage I Behavioral Intervention Development by algorithm development and testing of Epic Healthy Planet (HP) at UCD to identify patients at risk, but never screened for colon cancer or lung cancer. Aim #2 (R61 and R33): Utilizing the enhanced Epic HP, pilot-test evidence-based and customized interventions at both UCD and UCI to increase colon and lung cancer screening rate for at-risk individuals by 10%. Aim #3 (R61 and R33): Determine effectiveness of “bundled ordering” by assessing patients prior to their primary care visit for eligibility for colon and lung cancer screening, tobacco and obesity counseling, age-appropriate vaccination, and hepatitis C screening compared to single procedures in terms of time-saved. Aim #4 (R33): Conduct Stage IV Behavioral Intervention Development by expansion of CLOVER to the UCI federally qualified health center. Aim #5 (R61 and R33): Evaluate the impact of CLOVER on increasing adherence to selected USPSTF recommendations and reducing their disparities by demographic group. CLOVER will cleverly tailor Epic HP to institute 3 key interventions with multi-centered dissemination which will increase the aforementioned screenings, counseling, and vaccinations: 1) Electronic “bulk messaging” through the UCD patient-physician portal using messages that resonate by racial/ethnic groups, 2) “Bundled ordering” will be used by CLOVER staff to fulfill deficiencies in USPSTF and CDC recommendations simultaneously. This will include the use of the emerging technology video visits by which patients will connect to certified tobacco and obesity counselors using their smart phones without the need to travel to an appointment, and 3) “Tailored Health Maintenance” section in the patient's electronic medical chart will alert their PCP of remaining “care gaps” in USPSTF and CDC recommendations and facilitate shared decision making for patients who need additional counseling. If these Aims are achieved, adherence to USPSTF recommendations will be enhanced, and Epic, the EHR company who serves more than 250 million patients will consider incorporating CLOVER into its Foundation System for all organizations to consider adopting our approach.

项目总结为了改善医疗保健，缩小美国老龄化人口的健康差距，加州大学戴维斯分校(UCD)和加州大学欧文分校(UCI)合作提出了 “加强电子健康系统，减轻结肠癌、肺癌、肥胖症、疫苗可预防的疾病和肝癌“(”三叶草“)。三叶草的总体目标是发展，提供和传播基于电子健康系统(EHR)的干预措施，以改善通过增加对选定的美国预防服务工作组(USPSTF)等级的遵守来实现老年人 A级和B级建议以及疾病控制和预防中心(CDC)疫苗接种建议。我们将通过试点(R61)和临床试验(R33)阶段使用以下具体目标：目标1(R61)：通过算法进行第一阶段行为干预开发 UCD开发和测试Epic Healthy Planet(HP)以识别有风险的患者，但从未筛查结肠癌或肺癌。目标2(R61和R33)：利用增强的Epic HP，以循证为基础的试行测试并在UCD和UCI进行定制干预，以提高结肠癌和肺癌的高危筛查率个人数量增加10%。目标3(R61和R33)：通过评估患者来确定“捆绑排序”的有效性在他们有资格进行结肠癌和肺癌筛查、烟草和肥胖咨询的初级保健访问之前，在节省时间方面，与单一程序相比，适合年龄的疫苗接种和丙型肝炎筛查。目标#4(R33)：通过将三叶草扩展到UCI进行第四阶段行为干预开发联邦合格的医疗中心。目标5(R61和R33)：评估三叶草对增长的影响坚持USPSTF选定的建议，并按人口群体缩小他们的差距。三叶草将巧妙地为Epic HP量身定做3项多中心传播的关键干预措施，这将增加上述筛查、咨询和疫苗接种：1)通过使用种族/民族共鸣的UCD患者-医生门户网站，2)“捆绑订购” 将被三叶草工作人员用来同时满足USPSTF和CDC建议中的不足。这将包括使用新兴技术视频访问，患者将通过该访问连接到经过认证的烟草肥胖顾问使用他们的智能手机，而不需要出差去预约，以及3)“量身定制患者电子病历中的“健康维护”部分将提醒他们的PCP注意剩余的“护理缺口” 在USPSTF和CDC的建议中，并促进需要额外治疗的患者的共享决策心理咨询。如果实现了这些目标，将加强对USPSTF建议的遵守，并且EPIC，这家为超过2.5亿名患者提供服务的EHR公司将考虑将三叶草纳入其基金会系统供所有组织考虑采用我们的方法。