Web System for Engaging Families & Doctors in Continuous Asthma Quality Improveme

描述（由申请人提供）：哮喘影响了8%的美国儿童，是急诊科就诊、住院、缺课、痛苦和死亡的主要原因。它对低收入少数族裔的影响尤为严重。这一建议旨在克服卫生保健提供实施国家哮喘指南的障碍——临床医生未能提供基于指南的护理和患者在提供适当治疗时的依从性。该项目将开发并测试创新的基于网络的决策支持系统（CHADIS）的有效性，以支持医生和患者在持续提高医生哮喘护理质量和让家长和儿童参与自身护理的并行过程中进行合作。CHADIS让家长完成会诊前问卷调查，从而为医生在会诊中使用的患者特定决策提供支持。患者将通过CHADIS在访问前和访问之间在线完成儿科哮喘控制和沟通工具（PACCI），这是一份最近由一名联合研究者在一系列人口统计学中验证的哮喘症状问卷。在访问期间，医生与CHADIS决策支持部门的互动产生了重新认证学分的文件，并触发了针对每个孩子的个性化家长教育，这些教育出现在一个名为“记忆书/护理门户”的诱人网站上。患者的依从性是通过问题解决咨询，由临床医生提示的访问前数据的症状和障碍。还可以在Care Portal中为患者提供定制的默认消息和警报，这些消息和警报也可以由远程教练监控。期望在就诊之间监测哮喘症状，CHADIS使用多种形式的自动通信（短信、电子邮件和电话）来提示PACCI的完成。此外，鼓励家长通过多模式强化问卷调查，包括：记忆书、免费产品优惠券和“游戏化”，即娱乐视频和智力游戏，以进行个性化的患者教育。在第一阶段，该系统建立在专业和患者反馈和试点的基础上，并提交给医学专业委员会，以获得正式的QI MOC认证。在第二阶段，该系统将进一步完善，然后通过采用聚类随机对照设计的大型干预研究测试其改善哮喘控制的有效性。III期产品将具有市场价值，因为它改善并记录了质量改进、认证信誉维护、有意义的使用、临床质量测量、绩效付费和医疗之家的努力。

DESCRIPTION (provided by applicant): Asthma affects 8% of US children and is a leading cause of ED visits, hospitalization, missed school, suffering and death. It disproportionately affects low income minorities. This proposal seeks to overcome health care delivery barriers to implementation of national asthma guidelines - both clinician failures to provide guideline based care and patient adherence when appropriate treatments are offered. This project will develop and then test effectiveness of an innovative web-based decision support system (CHADIS) to support teaming doctors and patients in parallel processes of continuous quality improvement of asthma care for doctors and engagement of parents and children in their own care. CHADIS engages parents in completing pre-visit questionnaires, which trigger patient specific decision support for doctors for use in the visit. Patients will complete the Pediatric Asthma Control & Communication Instrument (PACCI), a questionnaire of asthma symptoms recently validated across a range of demographics by one of the co-investigators, online via CHADIS pre-visit and between visits. Doctor interaction with CHADIS decision support during the visit results in both documentation for recertification credit and triggering of individualized parent education to appear in an enticing website for each child called the Memory Book/Care Portal. Patient adherence is addressed through Problem Solving Counseling by the clinician prompted by the pre-visit data on symptoms and barriers. Patients also are provided tailored default messages and alerts in the Care Portal which can also be monitored by a remote coach. Monitoring of asthma symptoms between visits is expected and CHADIS uses multiple forms of automated communication (texting, email, and phone) to prompt completion of the PACCI. In addition, parents are encouraged to do questionnaires through multimodal reinforcements including: the Memory Book, coupons for free products and "gamification" i.e. entertaining videos and quiz games for individualized patient education. In Phase I the system is built with professional and patient feedback and piloting and presented to medical specialty boards for formal QI MOC certification. In Phase II the system is further refined and then tested for effectiveness in improving asthma control by a large intervention study using a cluster randomized control design. The Phase III product will have market value as it improves and documents care for Quality Improvement, Maintenance of Certification credit, meaningful use, clinical quality measurement, pay for performance and Medical Home efforts.