Integrated Online Assessment and Intervention Targeting Health Disparities

描述（由申请人提供）：社会经济和其他因素，如种族，民族，收入，教育和居住地与获得医疗保健的机会减少和质量较差有关。为弱势群体服务的临床医生经常超负荷工作，几乎没有机会收集对患者的全面生物医学和心理社会（生物心理社会，BPS）评估。这种情况是不幸的，因为许多身体症状在医学上无法解释，反映了高症状报告或潜在的心理社会问题，如抑郁症，创伤或耐受性差的压力。这些BPS因素对于来自弱势群体的患者尤其成问题。最后，严重的，医学上无法解释的症状，心理问题和生活质量差（QOL）一起发生在一个亚组的风险个体（ARI），其中包括约20%的典型临床人群。急性呼吸道感染者面临着结果不佳和护理不当费用高昂的风险，这一问题在弱势群体和少数群体中更为严重，因为他们获得初级保健的机会有限，紧急护理比预防性护理更为普遍。解决方案：我们的目标是部署临床方法和基础设施，以确保为少数民族和弱势患者提供以患者为中心的护理。我们的工作建立在一个名为CarePrep的在线患者自我评估系统上，该系统现已在临床上投入使用。CarePrep允许患者从家中或诊所通过互联网轻松输入和跟踪BPS和QOL数据。然而，仅仅将抑郁症的诊断交给临床医生并不会改变结果。因此，我们还将部署综合干预措施，以支持BPS护理。方法：1）我们将适应，提高文化敏感性，部署，完善，并在初级保健环境中初步验证CarePrep。我们的目标是满足患者和临床医生对加强沟通和以患者为中心的护理的需求，确保BPS问题被揭露。将要求患者在门诊前进行CarePrep。我们将评估有效性、可行性和CarePrep准确识别需要额外关注（ARI）的患者的能力，如严重症状、社会心理问题、生活质量受损或药物滥用。2)我们将分析和制定一个计划，支持文化能力，BPS护理使用自动化CarePrep功能，培训和支持护理经理或现有的诊所工作人员提供简单，简短的BPS干预和远程医疗支持的一些组合。IMPACT源于1）创建一个系统，为患者、临床医生和管理人员产生足够的价值，以保证日常使用; 2）创建一个简化的分支评估，最大限度地减少冗余并最大限度地提高相关性，从而支持收集全方位的相关数据，并提供与背景相关的教育和指导; 3）使用这种技术和临床方法来超越少数民族和弱势群体护理的障碍，以及4）识别，表征和针对这些人群中最需要和最高利用率的患者进行护理，从而促进有限的医疗费用的成本有效使用。

DESCRIPTION (provided by applicant): Socioeconomic and other factors such as race, ethnicity, income, education, and place of residence are associated with reduced access to and poorer quality healthcare. Clinicians serving disadvantaged populations are often overloaded, and have little chance to gather a comprehensive biomedical and psychosocial (biopsychosocial, BPS) evaluation of patients. This situation is unfortunate because many physical symptoms are medically unexplained, reflecting a pattern of high symptom reporting or underlying psychosocial issues, such as depression, trauma, or poorly-tolerated stress. These BPS factors are particularly problematic for patients from disadvantaged populations. Lastly, severe, medically unexplained symptoms, psychosocial issues, and poor quality of life (QOL) occur together in a subset of at-risk individuals (ARI), which comprises about 20% of typical clinic populations. ARI are at risk for poor outcomes and high costs from inappropriate care, a problem that is compounded in disadvantaged and minority populations where access to primary care is limited and urgent care is more prevalent than preventive care. SOLUTION: Our objective is to deploy a clinical methodology and infrastructure to ensure delivery of patient-centered care to minority and disadvantaged patients. Our work builds on an online, patient self-assessment system called CarePrep, now operational in clinic. CarePrep allows patients to easily enter and track BPS and QOL data over the Internet from home or clinic. However, just handing a diagnosis of depression, for example, to a clinician does not change outcomes. Therefore, we will also deploy an integrated intervention to support BPS care. APPROACH: 1) We will adapt, enhance cultural sensitivity, deploy, refine, and initially validate CarePrep in a primary care setting. Our goals are to meet the needs of patients and clinicians for enhancing communication and patient- centered care, ensuring that BPS issues are uncovered. Patients will be asked to do CarePrep before clinic. We will assess validity, feasibility, and CarePrep's ability to accurately identify patients who warrant extra attention (ARI) by findings such as severe symptoms, psychosocial issues, impaired QOL, or substance abuse. 2) We will analyze and develop a plan for supporting culturally competent, BPS care using some combination of automated CarePrep functionality, training and supporting care managers or existing clinic staff in delivering simple, brief BPS interventions, and telehealth support. IMPACT stems from 1) creating a system that generates sufficient value to patients, clinicians, and administrators to warrant routine use; 2) creating a streamlined, branching assessment that minimizes redundancy and maximizes relevance, thereby supporting collection of the full spectrum of relevant data and delivery of context-relevant education and guidance; 3) using this technology and clinical methodology to transcend barriers to care for minorities and disadvantaged populations, and 4) identifying, characterizing, and targeting care to the patients with the greatest need and highest utilization within such populations, thereby facilitating cost-effective use of limited healthcare dollars.