Computer Assisted Autism Care (CAAC)

计算机辅助自闭症护理 (CAAC)

• 批准号: 7786097
• 负责人: STEPHEN M. DOWNS
• 金额: $ 43.1万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7786097
• 关键词: Computer; Assisted; Autism; Care; CAAC

DESCRIPTION (provided by applicant): Autism and autism spectrum disorders (ASD) are not uncommon in the United States. Early diagnosis, along with early, appropriate and consistent intervention is key for improved long term-outcomes in children with ASD. General practitioners, especially pediatricians, are now seeing more children than ever with ASD in their practices. Therefore, general practitioners must increase their knowledge and comfort level in caring for these children. However, research has demonstrated that primary care physicians are more likely to demonstrate outdated beliefs and views about ASDs compared to specialists. Additionally, research has found that while routine screening for ASD is recommended by several medical associations, only 8% of Pediatricians routinely screen for ASDs. Modern computer decision support strategies offer the best hope of equipping general practitioners to deal with the challenging task of diagnosing ASD as early as possible and ensuring the timely implementation of evidence-based treatment plans. We have developed a novel decision support system for implementing clinical guidelines in pediatric practices. CHICA (Child Health Improvement through Computer Automation) combines three elements: (1) pediatric guidelines encoded in Arden Syntax; (2) a dynamic, scannable paper user interface; and (3) an HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just-in-time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with it. We propose to expand CHICA to include ASD screening, diagnosis, and treatment parameters. The specific research aims of this application are to: (1) expand and modify an existing computer-based decision support system (CHICA) to assist pediatricians with identification and management of ASDs; (2) evaluate the effect of the CHICA system ASD screening and surveillance module on the early identification of ASD in four pediatric practices; (3) collect early data on the effect of the CHICA system on services provided to children diagnosed with ASD and how these affect patient outcomes. This study will include a randomized trial in which screening, diagnosis, and management of ASD before and after implementation of the CHICA system in intervention practices will be compared to control practices. To measure the effect of the CHICA system on ASD screening and diagnosis (aim 2), we will collect data from medical records, reviews of CHICA data, and surveys of providers. Our primary outcome measure of interest for this aim is the percent of children who are screened using an ASD specific screening tool at the 18 or 24-month visit. To evaluate the effect of the CHICA system on ASD treatment and management (aim 3), we will collect process, outcome, and satisfaction measures at baseline, 6 months and 12 months from children between the ages of 18 months and 5 years with a formal diagnosis of ASD. The primary outcome of interest for aim 3 is the number of guideline recommended activities/involvements that a child diagnosed with ASD receives.

描述(申请人提供)：自闭症和自闭症谱系障碍(ASD)在美国并不少见。早期诊断以及早期、适当和持续的干预是改善ASD儿童长期预后的关键。全科医生，特别是儿科医生，现在看到比以往任何时候都更多的儿童患有自闭症。因此，全科医生必须增加他们在照顾这些孩子方面的知识和舒适度。然而，研究表明，与专家相比，初级保健医生更有可能证明对自闭症的过时信念和观点。此外，研究发现，尽管几个医学协会推荐常规筛查ASD，但只有8%的儿科医生常规筛查ASD。现代计算机决策支持策略提供了最大的希望，使全科医生能够尽早诊断ASD并确保循证治疗计划的及时实施这一具有挑战性的任务。我们开发了一种新的决策支持系统，用于在儿科实践中实施临床指南。CHICA(通过计算机自动化改善儿童健康)结合了三个要素：(1)以雅顿语法编码的儿科指南；(2)动态、可扫描的纸质用户界面；以及(3)与现有电子病历系统兼容的HL7界面。其结果是一个系统，既可以在临床会诊期间向医生提供与患者相关的“及时”指南，又可以准确地从所有与之交互的人那里捕获结构化数据。我们建议扩展CHICA以包括ASD筛查、诊断和治疗参数。此应用程序的具体研究目的是：(1)扩展和修改现有的计算机决策支持系统(CHICA)，以帮助儿科医生识别和管理ASD；(2)评估CHICA系统ASD筛查和监测模块在四个儿科实践中对ASD早期识别的效果；(3)收集CHICA系统对向被诊断为ASD的儿童提供的服务的影响以及这些影响对患者预后的早期数据。这项研究将包括一项随机试验，在干预实践中对实施CHICA系统前后ASD的筛查、诊断和管理与对照实践进行比较。为了衡量CHICA系统对ASD筛查和诊断(目标2)的影响，我们将从医疗记录、CHICA数据审查和提供者调查中收集数据。我们的 对这一目标感兴趣的主要结果衡量标准是在18个月或24个月的访问中使用ASD特定筛查工具进行筛查的儿童的百分比。为了评估CHICA系统对ASD治疗和管理的影响(目标3)，我们将收集18个月到5岁之间被正式诊断为ASD的儿童在基线、6个月和12个月时的过程、结果和满意度测量。目标3感兴趣的主要结果是被诊断为自闭症的儿童接受的指南建议活动/参与的数量。