Understanding and Honoring Patients with Multiple Chronic Conditions

描述（由申请人提供）：目前的护理系统不能满足患有多种慢性疾病的老年患者的需求。这些患者接受更多相互矛盾的医疗建议，经历更差的生活质量、更多的身体残疾、更多的药物不良事件和更高的死亡率。患有多种慢性疾病的患者经常面临相互竞争和冲突的健康需求：例如，糖尿病患者可能会得到锻炼的建议，但关节炎引起的疼痛或肺部疾病引起的呼吸短促可能会限制活动。为了得到最好的治疗，患有多种慢性疾病的患者必须向他们的医生和其他医疗保健提供者传达对他们来说最重要的是什么，医生必须理解并支持患者的优先护理。不幸的是，我们经常不与患者讨论他们的优先事项或使他们成为护理的一部分。我们需要包括患者优先事项的护理计划，以及与所有护理人员共享的工具。但首先，我们必须了解是什么决定了患有多种慢性疾病的患者的优先事项，以及医疗保健提供者如何支持这些优先事项。在这个项目中，慢性病护理、卫生信息技术和参与式设计方法方面的专家将首先研究患有多种慢性病的患者如何理解和确定护理重点。研究结果将用于设计过程，在设计过程中，患者、他们的家庭护理人员和他们的医疗保健提供者将开发一个原型交互式优先计划，在患者和提供者之间共享。该项目主要针对患有骨关节炎、冠状动脉疾病和抑郁症的糖尿病患者。基于越来越多的国家实施有意义的使用要求，我们设想患者优先事项的文档和沟通最终将集成到患者和医疗保健提供者之间共享的电子健康记录中。然而，我们的研究将确定何时需要纸质、电话和面对面的沟通，以确保患者和提供者之间的共同理解和持续沟通。我们还将评估我们对参与式设计方法的新应用，以告知它们在改善慢性护理项目中的潜在更广泛应用。我们的项目将帮助患者、护理人员和医生管理复杂的个人健康信息，并指导信息技术开发人员使用设计元素，这些元素对于将患者优先级合并到电子健康记录中非常重要。

DESCRIPTION (provided by applicant): Current systems of care are not meeting the needs of older patients with multiple chronic health conditions. These patients receive more conflicting medical advice, and experience worse quality of life, more physical disability, more adverse drug events, and higher mortality than those without multimorbidity. Patients with multiple chronic conditions often face competing and conflicting health demands: for example, a person with diabetes may get advice to exercise but pain from arthritis or shortness of breath from lung disease can limit activity. To get the best care, patients with several chronic illnesses must communicate what is most important to them to their doctors and other healthcare providers, and doctors must understand and support patients' priorities for care. Unfortunately, we often do not talk to patients about their priorities or make them a part of care. We need care plans that include patients' priorities and tools for sharing them with all caregivers. But first, we must understand what shapes the priorities of patients with multiple chronic conditions and how these priorities can be supported by healthcare providers. In this project, experts in chronic disease care, health information technology, and participatory design methods will first study how patients with multiple chronic conditions understand and set priorities for care. The results will be used in a design process in which patients, their family caregivers, and their healthcare providers will develop a prototype interactive priority plan to be shared between patients and providers. The project focuses on patients with diabetes, who have some combination of osteoarthritis, coronary artery disease and depression. Based on increasing national implementation of meaningful use requirements, we envision the documentation and communication of a patient's priorities to eventually be integrated within an electronic health record shared between patients and healthcare providers. Our study, however, will establish when paper, telephone and in-person communications are needed to ensure common understanding and ongoing communication between patients and providers. We will also evaluate our novel use of participatory design methods to inform their potential wider use in projects that improve chronic care. Our project will help patients, caregivers, and doctors manage complex personal health information, and guide information technology developers on the design elements that are important for incorporating patient priorities into electronic health records.