Using Location-Based Smartphone Alerts within a System of Care Coordination

项目摘要/摘要： 我们将设计和实施一个健康信息技术支持的系统，以 改善住院或急诊科后的护理协调 参观。在没有护理连续性的情况下或当护理被 支离破碎。美国人越来越多地患有慢性病，并在 医疗保健分散在护理系统和提供者之间的地区。尽管 随着电子健康记录的日益普及，这些系统往往无法 支持临床医生和机构之间的协调。由此导致的护理失败 协调导致数十亿美元的浪费性支出，包括以下结果 再次入院治疗。尽管选定的护理协调干预措施可以减少 住院人数和改善慢性病患者报告的结果， 护理协调方案往往无法实现其所宣称的目标，而且 在全球范围内节约成本。协调护理的新的、有可能复制的方法是 因此迫切需要。智能手机可能会提供一种新的、更灵活的方法 促进护理协调的信息传输。位置感知技术是 已经在许多智能手机应用程序(APP)中使用，并有可能 可靠地检测到患者何时在任何医院或急诊科接受治疗 基于手机的全球定位系统(GPS)坐标。跟随探索性 通过我们团队的研究，这项拟议的研究将开发和测试一种新的护理系统 智能手机应用程序向护理经理发送基于位置的警报的协调 在联邦合格的健康中心，当他们的高危患者在 地区医院或急诊室。我们将使用“混合效能-- 我们的主要研究问题集中在干预上的实施设计 Impact和我们的次要研究问题集中在障碍和促进者上 实施。这项研究的目的是：1)开发一个护理协调系统在 其中一款新的智能手机应用Chaser(协调医院和急救使用 支持智能手机提醒)，便于信息传输和护理 住院和急诊后的协调；以及2)进行 可行性研究审查该系统的初步影响和在 针对高危患者的护理管理计划。

Project Summary/Abstract: We will design and implement a health information technology-enabled system to improve care coordination following an inpatient admission or emergency department visit. Care coordination is required in the absence of continuity of care or when care is fragmented. Americans increasingly live with chronic diseases, and receive care in regions where care is fragmented across care systems and providers. Despite the increasing ubiquity of electronic health records, these systems are often unable to support coordination between clinicians and settings. Resulting failures in care coordination result in billions of dollars in wasteful spending, including outcomes such as hospital readmissions. Although selected care coordination interventions can reduce hospital admissions and improve patient-reported outcomes in chronically ill populations, care coordination programs often fail to achieve their stated objectives and are not globally cost saving. New, potentially replicable approaches to coordinating care are therefore urgently needed. Smartphones may offer a new, more nimble approach to information transfer that facilitates care coordination. Location-sensing technologies are already used in a host of smartphone applications (apps), and have the potential to reliably detect when patients receive care at any hospital or emergency department based on a phone’s Global Positioning System (GPS) coordinates. Following exploratory research by our team, the proposed study will develop and test a new system for care coordination in which a smartphone app sends location-based alerts to care managers at a federally qualified health center when their high-risk patients receive care at a regional hospital or emergency room. We will use a ‘hybrid effectiveness- implementation’ design in which our primary research questions focus on intervention impact and our secondary research questions focus on barriers and facilitators to implementation. The aims of this study are to: 1) Develop a care coordination system in which a novel smartphone app, CHASER (Coordinating Hospital And emergency use with Smartphone-Enabled Reminders), facilitates information transfer and care coordination following inpatient admissions and emergency visits, and; 2) Conduct a feasibility study examining the system’s preliminary impacts and implementation in a care management program for high-risk patients.