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

描述（由申请人提供）：哮喘影响8%的美国儿童，是导致艾德就诊、住院、缺课、痛苦和死亡的主要原因。它不成比例地影响低收入少数群体。该提案旨在克服实施国家哮喘指南的医疗保健提供障碍-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一个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医生哮喘护理的持续质量改进以及父母和儿童参与自己护理的并行过程中进行合作。CHADIS让家长完成访视前问卷，这些问卷会为医生提供针对患者的决策支持，供医生在访视中使用。患者将完成儿科哮喘控制和交流工具（PACCI），这是一份由一名合作研究者最近在一系列人口统计学中验证的哮喘症状问卷，通过CHADIS在线进行访视前和访视之间。在访问期间，医生与CHADIS决策支持的互动导致了重新认证学分的文件和个性化父母教育的触发，这些文件出现在一个名为记忆书/护理门户的诱人网站上。患者依从性通过临床医生根据访视前症状和障碍数据提示的问题解决咨询来解决。患者还可以在护理门户中获得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进行监控。预期在访视之间监测哮喘症状，CHADIS使用多种形式的自动通信（短信、电子邮件和电话）来提示完成PACCI。此外，鼓励家长通过多模式强化进行问卷调查，包括：记忆书、免费产品优惠券和“游戏化”，即娱乐视频和问答游戏，用于个性化患者教育。在第一阶段，该系统是建立与专业和患者的反馈和试点，并提交给医疗专业委员会正式QI MOC认证。在第二阶段，该系统进一步完善，然后通过一项大型干预研究，采用随机分组对照设计，测试其在改善哮喘控制方面的有效性。第三阶段的产品将具有市场价值，因为它改善和文件照顾质量改进，认证信用的维护，有意义的使用，临床质量测量，绩效支付和医疗家庭的努力。

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.