Pediatric Patient Engagement as a Criteria for Meaningful Use Stage 3

项目摘要/摘要 联邦政府拨款270亿美元，为一项分阶段计划提供资金，以促进有意义地使用 电子健康记录。有意义使用计划(MU3)的第三阶段优先考虑家庭拥有 能够提交患者生成的健康信息，以改善优先情况下的医疗保健绩效 并提高护理参与度。患者门户、允许患者互动的在线医疗应用程序 并与其医疗保健提供者进行沟通，提供了实现这些目标的理想工具，但 使用门户实现这一目标以及跨不同儿科实践使用对临床护理的影响 尚未建立设置。在AHRQ的三个优先事项中重点关注哮喘，这是AHRQ的优先情况 人口、儿童、低收入和特殊卫生保健需求，该议定书将直接解决这些问题 关键的知识差距，以便为MU3的政策和实践实施提供信息。 借鉴实施科学，本研究评估了实施成功的决定因素， 实施结果，以及实施哮喘门户后产生的医疗保健结果 国家，AHRQ资助，儿科实践研究和学习中心。从技术上讲，门户网站 将通过两种创新方法实施，以促进多个电子产品的快速循环评估 健康记录系统。尽管许多患者门户是用于传输有关 即将到来的预约、测试结果或实验室发现，该项目中的哮喘门户网站已经开发完成 并通过严格的以用户为中心的设计流程进行了测试，扩展了这一基本功能以提供哮喘 教育，收集患者报告的结果，评估药物使用和副作用，并跟踪父母的 偏好和目标。 这项研究的政策相关性将通过儿童医院的合作得到保证 费城政策实验室在综合研究结果为政策提供信息方面拥有特殊的专业知识，以及 美国儿科学会的儿童健康信息学中心，该中心已经积极与国家健康信息中心办公室合作 卫生信息技术协调员制定儿科MU指南，并将聘用 AAP的充分传播能力，以确保所有适当的利益攸关方都能获得调查结果。两者都有 小组已经通知了该提案的三个具体目标，即采用混合方法：(1)研究 使用EHR链接的门户网站提供教育并使家庭能够 传达治疗关切和目标，并报告症状控制、药物使用和副作用 哮喘儿童；(2)对于哮喘控制不佳或药物副作用较大的儿童， 评估通过门户网站从家庭收集数据对哮喘管理的影响 与初级保健临床团队分享；及(3)描述障碍和解决方案，以改善 跨实践环境实施门户的采用率、可持续性和对临床护理的影响。

PROJECT SUMMARY/ABSTRACT The federal government has allocated $27 billion to fund a staged program to foster the meaningful use of electronic health records. Stage 3 of the meaningful use program (MU3) prioritizes that families have the ability to submit patient-generated health information to improve health care performance on priority conditions and improve engagement in care. Patient portals, online healthcare applications that allow patients to interact and communicate with their healthcare providers, offer an ideal tool to achieve these goals, but the feasibility of using portals to achieve this goal and the impact of use on clinical care across diverse pediatric practice settings has not been established. Focusing on asthma, an AHRQ priority condition, in three AHRQ priority populations, children, low income, and special health care needs, this protocol will directly address these critical knowledge gaps in order to inform MU3 policy and practice implementation. Drawing from implementation science, this study evaluates the determinants of implementation success, implementation outcomes, and health care outcomes resulting from implementing an asthma portal in a national, AHRQ-funded, Center for Pediatric Practice-Based Research and Learning. Technically, the portal will be implemented with 2 innovative approaches that facilitate rapid cycle evaluation in multiple electronic health record systems. Although many patient portals are simple vehicles for transferring information about upcoming appointments, test results or laboratory findings, the asthma portal in this project, already developed and tested through a rigorous user-centered design process, extends this basic functionality to provide asthma education, collect patient-reported outcomes, evaluate medication use and side effects, and track parents' preferences and goals. Policy relevance of this research will be assured through the collaboration of The Children's Hospital of Philadelphia's PolicyLab, which has particular expertise in synthesizing research findings to inform policy, and the AAP's Child Health Informatics Center, which already is actively engaged with the Office of the National Coordinator for Health Information Technology in establishing guidelines for MU in pediatrics and will employ the full dissemination capabilities of the AAP to ensure that findings reach all appropriate stakeholders. Both groups have informed the proposal's 3 specific aims that utilize mixed methods: (1) To study the feasibility for pediatric primary care practices of using an EHR-linked portal to provide education and enable families to communicate treatment concerns and goals and report symptom control, medication use and side effects for children with asthma; (2) For a subset of children with poorly controlled asthma or medication side effects, to assess the impact on asthma management resulting from gathering data from families through the portal and sharing them with the primary care clinical team; and, (3) To describe barriers and solutions to improve the adoption, sustainability, and impact on clinical care of implementing portals across practice settings.