A Mobile Personal Health Record for Behavioral Health Homes

描述(由申请人提供)：糟糕的医疗质量是严重精神疾病患者过度医疗发病率和过早死亡的主要原因。为了解决这一问题，社区精神卫生提供者越来越多地与安全网医疗提供者合作，开发行为健康之家，即综合诊所，在那里，患有SMI的人可以得到协调的医疗和精神健康护理。然而，行为健康之家在跨组织整合电子病历方面面临着后勤和隐私方面的挑战。该应用程序建议开发和测试移动个人健康记录(MPHR)，以克服这一问题，同时更充分地让患者参与他们的医疗保健。MPHR将有能力实时获取医疗和精神健康药物和实验室数据；帮助客户设定和维护健康和生活方式目标；提供药物和预约提示和提醒；以及通过与EHR的异步通信促进与提供者的沟通。这项分三个阶段进行的研究将开发、测试和传播MPHR。在第一阶段，我们将根据基于PC的PHR项目的经验和初步数据开发这款应用程序，并将其链接到行为健康之家的医疗和心理健康EHR。在第二阶段，我们将在300名随机接受MPHR或常规护理的受试者中进行MPHR的随机试验。这项研究将使用适应性设计，将在60名受试者的5个6个月队列中实施该应用程序。在每个队列之后，该应用程序将根据可行性和可接受性调查结果、PHR应用程序的新研究和商业发展以及临床和社区实践中常规护理的变化进行更新。分析将检查干预的总体影响，以及在研究队列中其好处是否发生变化。研究结果将包括预防和心血管护理的质量；慢性病的患者激活和提供者管理；以及服务使用，包括药物依从性、错过预约、急诊科使用以及从社会和管理角度看的护理成本。在干预的最后阶段，该APP将通过国家技术援助中心分发给全国各地的行为健康家庭。这项拟议的研究将应用一种以前从未在精神健康环境中研究过的新技术，将在一种新的护理组织模式下进行，预计这种模式将在未来几年在社区精神健康中普及，并将使用创新的适应性设计，确保干预措施在整个研究期间保持相关性和更新。一个由精神健康服务研究人员、信息技术和应用程序设计专家以及在公共部门整合方面拥有专业知识的政策制定者组成的多学科团队将有助于确保研究结果将有助于改变精神健康安全网环境中的护理提供。

DESCRIPTION (provided by applicant): Poor quality of medical care is a major contributor to excess medical morbidity and premature mortality in persons with serious mental illnesses (SMI). To address this problem, community mental health providers are increasingly partnering with safety net medical providers to develop behavioral health homes, integrated clinics in which persons with SMI receive coordinated medical and mental health care. However, behavioral health homes have faced logistical and privacy challenges in integrating electronic medical records across organizations. This application proposes to develop and test a mobile Personal Health Record (mPHR) to overcome this problem while more fully engaging patients in their health care. The mPHR will have the capability to access medical and mental health medication and lab data in real time; to help clients set and maintain health and lifestyle goals; to provide medication and appointment prompts and reminders; and to facilitate communication with providers via asynchronous communication with the EHRs. This three-phase study will develop, test, and disseminate the mPHR. During the first phase, we will develop the app building on experience and preliminary data from a PC-based PHR project, and link it to the medical and mental health EHR in a behavioral health home. During the second phase, we will conduct a randomized trial of the mPHR in 300 subjects randomized to the mPHR or usual care. The study will use an adaptive design, which will implement the app in five 6-month cohorts of 60 subjects. After each cohort, the app will be updated based on feasibility and acceptability findings, new research and commercial developments in PHR apps, and changes in usual care in the clinic and community practice. Analyses will examine overall effects of the intervention, and whether there is a change in its benefits across study cohorts. Study outcomes will include quality of preventive and cardiovascular care; patient activation and provider management of chronic illness; and service use including medication compliance, missed appointments, emergency department use, and costs of care from a societal and managerial perspective. During the final phase of the intervention, the app will be disseminated to behavioral health homes across the country through a national technical assistance center. The proposed study will apply a novel technology that has not previously been studied in mental health settings, will be conducted in a new organizational model of care that is anticipated to become widespread in community mental health in the coming years, and will use an innovative adaptive design that will ensure that the intervention remains relevant and updated throughout the study period. A multidisciplinary team including mental health services researchers, experts in information technology and app design, and policymakers with expertise in public sector integration will help ensure that the study results will help transform care delivery in mental health safety net settings.