The Medication Metronome Project

描述(由申请人提供)：初级保健的一个主要目标是预防与高血压、2型糖尿病和高脂血症等常见慢性病相关的发病率和死亡率。然而，国家和地方数据表明，无论是在风险因素控制方面，还是在监测相关不良药物事件方面，我们都远远达不到针对这三种情况的循证目标。尽管有许多因素导致了次优护理，但风险因素水平升高的患者缺乏及时的药物强化和安全监测，已被确定为有效和安全的慢性病护理的普遍和潜在的可改变的障碍。我们目前的初级保健系统在很大程度上是基于对急性主诉的间歇性、基于走访的护理模式，这种模式不太适合纵向慢性疾病管理，特别是对于需要药物启动、监测和迭代剂量滴定以实现风险因素控制的情况。随着美国医疗保健系统开始向电子健康记录(EHR)过渡，健康信息技术(IT)的进步现在为开发和严格评估新的初级保健模式提供了机会。我们建议测试一种慢性病药物管理模型，在该模型中，启动或调整医疗治疗的决定与独立于办公室访问执行的一系列后续临床操作(例如，监测ADE、评估治疗反应、改变用药剂量)直接相关。我们假设，建立一个独立于来访、由卫生信息技术支持的实验室监测周期和迭代用药剂量调整将导致更有效的慢性病护理。为了实施这一模式，我们将建立在现有的电子病历和综合数据系统的基础上，开发一种名为“药物计时器”的先进医疗信息技术应用程序，以跟踪实验室测试的截止日期和结果，向患者和提供者报告结果，并促进提供者在两次就诊之间调整药物剂量。间隔和评估方式的选择将由提供者量身定做，以优化个人护理决策。这一干预措施的目标是开发一种有效的系统，以确保患者被迅速和安全地带到循证治疗目标，并通过消除对办公室访问的要求来防止计划中的实验室监测的延误。这项工作的更广泛的目标是通过将独立于就诊的药物管理与更有成效的基于就诊的护理相结合来促进更大的患者与医生之间的联系。需要卫生信息技术(IT)的新用途，以支持在初级保健环境中对慢性病进行更有效的药物管理。这项研究将在对照试验中评估IT系统的价值，该系统支持两次就诊之间的药物安全监测和剂量调整。这项研究与全国范围内严格展示实施新的基于IT的交付模式的最有效方法的努力有关，这些模式将护理扩展到传统的诊所就诊之外。

DESCRIPTION (provided by the Applicant): A major goal of primary care is to prevent the morbidity and mortality associated with common chronic diseases such as hypertension, type 2 diabetes, and hyperlipidemia. However, national and local data indicate that we are falling well short of evidence-based goals for these three conditions, both in terms of risk factor control and of monitoring for associated adverse drug events (ADEs). Although there are many contributors to sub-optimal care, lack of timely medication intensification and safety monitoring among patients with elevated risk factor levels has been identified as a prevalent and potentially modifiable barrier to effective and safe chronic disease care. Our current primary care system is based to a large extent on a model of episodic, visit-based care for acute complaints that is not well-suited for longitudinal chronic disease management, particularly for conditions that require medication initiation, monitoring, and iterative dose titration to achieve risk factor control. As the U.S. health care system begins the transition to electronic health records (EHRs), advances in health information technology (IT) now offer the opportunity to develop and rigorously evaluate new models of primary care. We propose to test a model of chronic disease medication management in which the decision to initiate or adjust medical therapy is directly linked to a sequence of subsequent, clinical actions (e.g. monitoring for ADEs, assessing response to therapy, changing medication dose) performed independently of the office visit. We hypothesize that establishing a visit-independent, health IT-supported cycle of laboratory monitoring and iterative medication dose adjustment will result in more effective chronic disease care. To implement this model, we will build on our existing EHR and integrated data systems to develop an advanced health IT application called the "Medication Metronome" to track laboratory test due dates and results, report results to both patients and providers, and facilitate between-visit medication dose adjustment by providers. The choices of interval and evaluation modality will be tailored by the provider to optimize individual care decisions. The goal of this intervention is to develop an efficient system to ensure that patients are rapidly and safely brought to evidence-based treatment goals and to prevent delays in planned laboratory monitoring by eliminating the requirement for an office visit. The broader goal of this work is to foster greater patient-physician connectedness by combining visit- independent medication management with more productive visit-based care. Novel uses of health information technology (IT) are needed to support more effective medication management for chronic diseases in the primary care setting. This study will evaluate in a controlled trial the value of an IT system that supports between-visit medication safety monitoring and dose adjustment. This research is relevant to nationwide efforts to rigorously demonstrate the most effective ways to implement new IT-based delivery models that expand care beyond the traditional clinic visit.