PA-20-070 Integrating Patient-Reported Outcomes into Routine Primary Care: Monitoring Asthma Between Visits

项目总结 新冠肺炎疫情给美国2500多万人带来了前所未有的风险 有哮喘的人。患有哮喘等慢性疾病的患者更有可能出现更糟糕的临床症状。 预后由新冠肺炎的呼吸道并发症引起。此外，新冠肺炎相关ED访问的风险 更严重的哮喘患者、少数族裔患者和低度哮喘患者的住院率可能更高。 社会经济地位。由于慢性疾病的常规护理正在减少，而维持性药物正在 没有填充物的哮喘患者病情恶化的风险更大。人们普遍认为，良好的哮喘 控制有助于预防哮喘恶化，目前的临床指南建议经常监测 但用于症状监测的有用工具和实践模型是 不可用。在之前的工作中，我们开发并测试了一个简单的移动健康(MHealth)应用程序，可以安装 在患者的智能手机上使用患者报告的结果(PRO)跟踪和自我报告哮喘症状 两次就诊之间，以及诊所将监测患者报告的症状作为常规的一部分的实践模式 关心。基于我们可行性研究的成功，我们目前正在扩大和扩大这一干预措施，以 为不同人群提供服务的初级保健诊所，包括讲西班牙语和健康素养低的人 病人。我们正在严格评估我们的临床集成mHealth干预措施在 即将开始的随机对照试验。在我们当前项目的这个补充中，我们将制作三个 增强最大限度地提高卫生系统和医疗保健专业人员应对新冠肺炎的能力。 首先，我们将使用新冠肺炎症状筛选器和相关教育功能来增强mHealth应用程序 材料。第二，我们将使用定量和定性方法来确定最佳实践、障碍和 在大流行期间招募病人到我们家进行监测干预的促进者。最后，我们会 开发并验证预测模型，以确定哪些哮喘患者可能从我们的 干预，使用电子健康记录(EHR)中提供的数据。识别、招募和安全地 在COVID期间监控可能利用急性和危重护理资源的高危患者- 19大流行是医疗系统应对的关键方面。我们的工作将展示医疗保健如何 系统可以使用数据驱动的方法来识别具有不良结果风险的患者，这些患者优先 受益于通过临床集成的数字干预对专业人员进行常规和远程监控。这个 从这些补充目标中获得的知识将使我们更清楚地了解卫生系统如何 可以使用健康IT通过改善改善来确保患有慢性病的患者的安全，例如哮喘 遵守指导方针。这样做不仅可以减轻新冠肺炎对这一人群的健康影响， 而且还可以将未来激增的急性和危重护理能力的压力降至最低。

PROJECT SUMMARY The COVID-19 pandemic presents an unprecedented risk for the 25+ million individuals in the United States who have asthma. Patients with chronic conditions such as asthma are more likely to have worse clinical outcomes due the respiratory complications of COVID-19. Furthermore, the risk of COVID-19 related ED visits and hospitalization is likely higher for patients with more severe asthma, minorities, and those of lower socioeconomic status. As routine care of chronic disease is declining and maintenance medications are unfilled, asthma patients are at even greater risk of exacerbations. It is widely established that good asthma control can help prevent asthma exacerbations and current clinical guidelines recommend frequent monitoring of asthma control in the ambulatory setting, but useful tools and practice models for symptom monitoring are unavailable. In prior work, we developed and tested a simple mobile health (mHealth) app that can be installed on patients' smartphones to track and self-report asthma symptoms using patient-reported outcomes (PRO) between visits, and a practice model for clinics to monitor the patient-reported symptoms as part of routine care. Based on the success of our feasibility study, we are currently scaling and spreading this intervention to primary care clinics that serves a diverse population, including Spanish-speaking and low health literacy patients. We are rigorously evaluating the effect of our clinically-integrated mHealth intervention in a randomized controlled trial which is soon to begin. In this supplement to our current project, we will make three enhancements to maximize health systems' and healthcare professionals' ability to respond to COVID-19. First, we will enhancement the mHealth app with a COVID-19 symptom screener and relevant educational materials. Second, we will use quantitative and qualitative methods to identify best practices, barriers, and facilitators for recruiting patients to our home monitoring intervention during the pandemic. Finally, we will develop and validate a predictive model to identify asthma patients who may benefit the most from our intervention, using data available from the electronic health record (EHR). Identifying, recruiting, and safely monitoring high-risk patients who could potentially utilize acute and critical care resources during the COVID- 19 pandemic are critical aspects of the healthcare system response. Our work will demonstrate how healthcare systems can use data-driven approaches to identify patients at risk for poor outcomes who would preferentially benefit from routine and remote monitoring of PROs via a clinically integrated digital interventions. The knowledge gained from these supplemental aims will provide a clearer understanding of how health systems might use health IT to keep the patients with chronic conditions, such as asthma, safe by improving compliance with guidelines. Doing so will not only mitigate the health effects of COVID-19 in this population, but also minimize the strain on acute and critical care capacity in future surges.