SBIR Phase I: eLearning system that enables patient-centered, team-based care and reduces physician shortages in medically underserved areas

小型企业创新研究(SBIR)第一阶段项目的更广泛影响/商业潜力是，通过开发一种工具来分析联邦合格健康中心(FQHC)的临床护理团队绩效数据，从而显著减少初级保健医生短缺，并提高美国低收入患者的护理质量，从而自动为工作人员部署个性化定制的电子学习支持，从而实现以患者为中心的团队护理。FQHC由美国卫生与公众服务部资助，为生活在全国1万多个最贫困社区的2200万低收入患者提供服务。实施良好的以患者为中心的团队护理有可能显着减少医生短缺和慢性病负担，慢性病对低收入社区的影响不成比例。然而，推动和维持FQHC参与这一模式的努力收效甚微，2016年只有66%获得了以患者为中心的医疗之家(PCMH)的认可。各种公共倡议，包括卫生资源和服务管理质量改进奖和医疗保险获取和芯片再授权法案(MACRA)，正在提供额外的财政激励措施，以推动初级保健做法获得PCMH的认可。然而，当前的实践转型方法繁琐且难以持续。拟议的项目旨在通过评估开发一种工具的可行性，以利用电子健康记录数据来确定糖尿病患者以患者为中心的团队护理中的差距，并根据护理团队的每个成员的表现为他们部署定制的异步个性化电子学习轻推类型支持，从而中断FQHC的持续健康专业教育。这项SBIR第一阶段的研究目标是确定通过API使用电子病历数据的可行性，以触发个人用户和团队级别的标志，以便与一套特定的PCMH标准和糖尿病临床协议产生差异；开发生成个性化学习者用户概况和团队级别报告的算法；生成数据以设计算法，以学习用户的偏好、对标志的影响和患者结果；设计用于奖励和认可的用户界面，并评估最终用户对电子学习工具的接受程度。这项研究将使用以用户为中心的设计、行为经济学和成人学习原则来收集具体需求，并开发最低限度的可行产品，重点放在5到10个指标的子集上。

The broader impact/commercial potential of this Small Business Innovation Research (SBIR) Phase I project is to significantly reduce primary care physician shortages and improve quality of care for low income patients in the United States by developing a tool that analyzes clinical care team performance data at federally qualified health centers (FQHCs) to automatically deploy individually tailored eLearning support for staff members that enables patient centered team based care. FQHCs are funded by the U.S. Department of Health and Human Services to serve 22 million low income patients living in more than 10,000 of the poorest communities across the Nation. Well-implemented patient centered team-based care has the potential to significantly reduce physician shortages and burden of chronic disease which disproportionately affects low income communities. However, efforts to move and sustain FQHCs participation in this model have had limited success with only 66% attaining patient centered medical home (PCMH) recognition in 2016. Various public initiatives, including the Health Resources and Service Administration Quality Improvement Award and Medicare Access and CHIP Reauthorization Act (MACRA), are providing additional financial incentives to move primary care practices towards PCMH Recognition. However, current approaches to practice transformation are cumbersome and difficult to sustain.The proposed project seeks to disrupt continued health professional education at FQHCs by assessing the feasibility of developing a tool that leverages electronic health record data to identify gaps in patient centered team based care for diabetic patients and deploys tailored asynchronous individualized e-learning nudge type support to each member of the care team based on their performance. The research objectives of this SBIR Phase 1 are to establish the feasibility of using EHR data through an API to trigger individual user and team level flags for variation from a specific set of PCMH standards and diabetes clinical protocols; to develop algorithms that generate an individualized learner user profile and teams level reports; to generate data to design algorithms that learn from user preferences, impacts on flags and patient outcomes; to design user interphase for reward and recognition and to evaluate end user acceptance of eLearning tools. The research will be approached using user centric design, behavioral economics and adult learning principles to gather specific requirements and develop a minimum viable product focused on a subset of between five to 10 indicators.