IBDPROMISE: A Web-based Patient-centric Model to Improve Quality and Outcomes

描述(申请人提供)：背景：衡量和提高医疗质量是一项重要的全国性挑战。关于质量和疾病管理的讨论很少在办公室访问期间发生，因为此时患者和提供者有一个独特的机会来听取彼此的意见并做出协作决定。假设：鼓励患者主动测量和改进质量可以为质量改进工作带来显著的效率、效果和成本节约。目标：获得设计和评估以患者为中心的模型IBDPROMISE(IBD患者报告结果和医学IIlness严重性评估)的技能，在该模型中，炎症性肠病(IBD)患者测量他们的护理质量指标(如结肠镜检查)以及生活质量 在候诊室和家里；医生在护理时使用这些信息来提高质量。该项目的具体目标是：“AIM I.根据国家建议，为IBD患者定义一套全面的护理质量指标(如免疫接种、适当的结肠镜监测)。”目的II.纵向测量护理质量指标和生活质量。“AIM III.进行随机对照试验 确定IBDPROMISE在改善结果(护理质量、生活质量、患者依从性、疾病控制和资源利用)方面的影响。方法：所有符合条件的成年患者在研究招募期间到达西奈山医院IBD中心和社区站点时，将在候诊室提供基于平板的问卷，并在征得同意后入选。在一个基准期(至少6个月)之后，IBDPROMISE ARM的参与者将被要求在18个月内每月报告他们的护理质量指标和生活质量。这将生成一张电子健康卡(详细说明疾病摘要、质量指标以及显示随时间推移的生活质量和医疗保健利用率趋势的图表)。患者和提供者将使用医疗卡、主动决策支持(分数下降)和被动决策支持(高质量仪表板和提醒)来协同提高护理质量。结果：研究的主要终点是每个组(IBDPROMISE与对照组)中在第104周达到所有合格质量指标的患者的比例。次要目标将是两个部门之间的生活质量、疾病控制率和医疗资源利用情况的比较。还将进行其他分析，以确定人口统计、社会经济地位和计算机素养对IBDPROMISE的采用和成果改进的影响。未来方向：这个项目将帮助我在自我管理、质量改进、临床试验设计以及生活质量数据和成本效益分析方面获得关键技能。 未来，IBDPROMISE及其在EHR中的护理点QI模型如果被证明成功，将免费提供给其他学术机构，并帮助我实施IBD的多点临床试验和前瞻性队列研究。

DESCRIPTION (provided by applicant): Background: Measuring and improving healthcare quality is an important national challenge. The discussion about quality and disease management rarely happens during office visits when patients and providers have a unique opportunity to listen to each other and make collaborative decisions. Hypothesis: Encouraging patients to proactively measure and improve quality can bring remarkable efficiency, effectiveness and cost-savings to quality improvement efforts. Goal: To acquire skills to design and evaluate a patient-centric model, IBDPROMISE (IBD Patient Reported Outcomes and Medical IIlness Severity Evaluation), in which patients with inflammatory bowel disease (IBD) measure their quality of care metrics (such as colonoscopy surveillance) as well as quality of life in waiting rooms and at home; and physicians use this information at the point of care for quality improvement efforts. The specific aims of the project are: " AIM I. Define a set of comprehensive quality of care metrics (such as immunization, appropriate colonoscopy surveillance) for IBD patients from national recommendations. " AIM II. Measure longitudinally quality of care metrics and quality of life (QOL). "AIM III. Conduct a randomized controlled trial to determine the impact of IBDPROMISE in improving outcomes (quality of care, quality of life, patient adherence, disease control and resource utilization). Methods: All eligible adult patients arriving in Mount Sinai Hospital IBD center and a community site during study recruitment will be offered tablet-based questionnaire in waiting rooms and enrolled once consented. After a baseline period (at least six months), participants in the IBDPROMISE arm will be asked to report their quality of care metrics and QOL every month for 18 months. This will generate an electronic health card (detailing disease summary, quality metrics and a graph showing the trend of QOL and healthcare utilization over time). Patients and providers will use the health card, active decision support (a drop in scores) and passive decision support (quality dashboards and reminders) to improve the quality of care collaboratively. Outcome: The primary end-point of the study is the proportion of patients in each group (IBDPROMISE vs. control) who meet all eligible quality metrics at week 104. Secondary endpoints will be comparison of quality of life, disease control rates and utilization of healthcare resources between the two arms. Additional analysis will be done to determine the impact of demographics, socioeconomic status and computer literacy on IBDPROMISE adoption and improvement in outcomes. Future Direction: This project will help me acquire critical skills in self-management, quality improvement, design of clinical trials and analysis of quality of life data and cost effectiveness. In the future, IBDPROMISE and its point of care QI model within EHR, if proven successful, will be made available license-free to other academic institutions, and help me implement multi-site clinical trials and prospective cohort studies in IBD.