The Virtual Patient for Improving Quality of Care in Primary Healthcare

描述（由申请人提供）：虽然创伤性生活经历与心理健康之间的关系已经确立，但新的研究正在揭示创伤性生活事件对身体健康的影响。这些研究证明了直接由于创伤事件以及通过创伤后应激障碍（PTSD）和抑郁症介导的身体健康问题的积极风险。初级卫生保健（PHC）是创伤相关精神健康障碍卫生保健系统的主要入口。然而，由于诊断和治疗不足，通常的初级卫生保健，特别是对处境不利的族裔群体，可能不够理想。麻省总医院/哈佛医学院的哈佛难民创伤项目（HPRT）、卡罗林斯卡研究所（KI）和林恩社区卫生中心（LCHC）将通过这笔拨款，率先开发基于计算机的模拟培训或虚拟病人（VP），用于识别和治疗与创伤相关的心理健康和健康障碍。这项拨款特别值得注意的是，它侧重于低收入、文化多样化、英语水平低（LEP）的患者的医疗/精神保健。该基金的主要研究目标包括：(1)由HPRT和KI在LCHC开发VP原型，该原型可以有效地培训初级保健提供者对来自不同文化背景的创伤初级保健患者的健康和精神健康问题的诊断和治疗；(2) VP对提高LEP患者护理质量影响的初步测试；(3)将副总裁培训以电子方式整合到LCHC设置中，供所有LCHC提供商访问；(4)建立在全州乃至全国范围内推广VP作为HIT重大创新的指导方针。这笔赠款是对受贫困和暴力影响社区初级保健的一项重大贡献。副总裁作为一项HIT创新，可以为弱势患者及其初级保健提供者提供可持续的培训和护理质量的提高。

DESCRIPTION (provided by applicant): While the relationship between traumatic life experiences and mental health has been well- established, new research studies are revealing the impact of traumatic life events on physical health. These studies are demonstrating the positive risk for physical health problems directly due to trauma events as well as mediated through posttraumatic stress disorder (PTSD) and depression. Primary health care (PHC) is the primary entry point to the health care system for trauma related mental health disorders. Yet, the usual primary health care, especially for disadvantaged ethnic groups, may be less than optimal due to under-diagnosis and under- treatment. The Harvard Program in Refugee Trauma (HPRT) at Massachusetts General Hospital/Harvard Medical School, the Karolinska Institute (KI), and the Lynn Community Health Center (LCHC) through this grant will be one of the first to develop a computer-based simulation training or Virtual Patient (VP) for the identification and treatment of trauma-related mental health and health disorders. This grant is especially noteworthy for its focus on the medical/mental health care of low-income, culturally diverse patients with low English proficiency (LEP). Major research goals of this grant include: (1) development of a VP prototype at LCHC by HPRT and KI that can effectively train PHC providers on the diagnosis and treatment of health and mental health problems in traumatized PHC patients from culturally diverse backgrounds; (2) preliminary testing of impact of the VP on improving the quality of care of LEP patients; (3) electronically integrating the VP training into the LCHC settings for access by all LCHC providers; (4) establishing guidelines for state-wide and national dissemination and research on the generalization of the VP as a major HIT innovation. This grant represents a major contribution in the PHC of communities affected by poverty and violence. The VP as a HIT innovation can provide sustainable training and quality of care improvement for disadvantaged patients and their PHC providers. PUBLIC HEALTH RELEVANCE: The Harvard Program in Refugee Trauma (HPRT) of Massachusetts General Hospital/ Harvard Medical School, the Karolinska Institute and the Lynn Community Health Center are preparing this grant to develop a computer-based patient simulation or Virtual Patient (VP) for use in primary health care (PHC) settings. This will be the first use of VP in PHC to aid in the identification and treatment of trauma-related health and mental health problems in highly traumatized, culturally diverse patients. This VP prototype will provide sustainable Health Information Technology (HIT) training and clinical quality of care improvement for disadvantaged communities and their PHC providers.