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

项目概要/摘要： 我们将设计和实施一个卫生信息技术驱动的系统， 改善住院或急诊后的护理协调 访问在缺乏连续性护理或护理缺乏连续性的情况下， 支离破碎越来越多的美国人患有慢性病， 各护理系统和提供者的护理分散的地区。尽管 随着电子健康记录的日益普及，这些系统通常无法 支持临床医生和环境之间的协调。导致护理失败 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。虽然选择的护理协调干预措施可以减少 住院率和改善慢性病患者报告结果， 护理协调计划往往无法实现其既定目标， 全球成本节约。新的，可能可复制的协调护理方法是 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， 信息传递，促进护理协调。位置感应技术 已经在许多智能手机应用程序（应用程序）中使用，并有可能 可靠地检测患者何时在任何医院或急诊科接受护理 基于手机的全球定位系统（GPS）坐标。以下探索性 通过我们团队的研究，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 当他们的高危病人在一个有资格的联邦健康中心接受治疗时， 地区医院或急诊室。我们将使用"混合效率- 我们主要研究问题集中于干预的实施设计 影响和我们的次要研究问题集中在障碍和促进因素， 实施.本研究的目的是：1）建立一个护理协调系统， 这是一款新颖的智能手机应用程序，CHASER（协调医院和紧急使用 智能手机功能的提醒），方便信息传输和护理 在住院和急诊就诊后进行协调; 2） 可行性研究，探讨该系统的初步影响和实施情况， 高风险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.