Quality Improvement and Practice Based Research in Neurology Using the EMR

 描述(由申请人提供)：建议研究的目标是利用电子病历(EMR)推进神经病学的质量改进和实践研究。美国神经病学学会(AAN)已经发布了几种神经疾病的循证指南、质量改进措施和资源。然而，AAN准则和措施没有得到常规执行，也缺乏基准数据。根据最佳实践，几乎没有EMR工具可用于标准化神经科办公室就诊、在神经科护理偏离AAN指南时发出警报、捕获有关遵守AAN或其他质量参数的数据、衡量遵守指南对结果的影响、共享纵向数据和比较神经实践中的护理效果。NorthShore University HealthSystem(NorthShore)神经病学系已将其商业EMR“Epic”结构化临床文档支持(SCDS)和临床决策支持(CDS)工具内置于其商业EMR“Epic”结构化临床文档支持(SCDS)和临床决策支持(CDS)工具中，这些工具可标准化护理、编写进度说明，并在每次就诊时捕获多达1,000个离散和级联的神经学数据。然而，这些EMR工具还没有被传播用于其他神经学实践或数据共享，目前也不支持临床试验。使用EMR的务实试验将使在护理点进行治疗比较成为可能。为了解决神经病学在质量改进和以实践为基础的研究方面的差距，我们向医疗保健研究和质量机构(AHRQ)提出了一个具有具体目标的项目：1)创建一个基于神经学实践的研究网络(NPBRN)。NorthShore网站将与其他7个也使用Epic EMR平台的神经科共享10种常见神经疾病(脑瘤、癫痫、偏头痛、轻度认知障碍、轻度创伤性脑损伤、多发性硬化症、神经病、帕金森病、不宁腿综合征和中风)的SCDS和CDS工具(共8个站点)。2)在NorthShore进行使用EMR治疗10种常见神经疾病的实用试验。我们将演示基于分组的适应性治疗分配、电子同意以及使用EMR在护理点捕获结果数据的可行性。我们将确定最有效的治疗常见神经疾病的方法，并寻求NPBRN的复制。我们的目标是创新的，因为我们将使用EMR来硬连接神经学的质量和结果研究。我们将通过使用基于子组的适应性设计进行实用化试验，比较常见神经疾病的现有治疗方法的有效性，在护理点个性化药物。我们的目标意义重大，因为我们正在研究几种神经疾病，这是全球医疗负担的主要原因。我们将建立一个以国家实践为基础的网络，通过加快实施以患者为中心的神经病学成果研究，利用EMR和证据，使医疗更安全，提高医疗效率，从而提高医疗质量。

 DESCRIPTION (provided by applicant): The goals of the proposed research are to advance quality improvement and practice based research in Neurology using the electronic medical record (EMR). The American Academy of Neurology (AAN) has published evidence-based guidelines, quality improvement measures, and resources for several neurological disorders. However, the AAN guidelines and measures have not been implemented routinely and benchmark data are lacking. There are few EMR tools available to standardize neurology office visits according to Best Practices, to provide alerts when neurological care is deviating from AAN guidelines, to capture data regarding adherence to AAN or other quality parameters, to measure the effects of compliance with guidelines on outcomes, or to share longitudinal data and to compare effectiveness of care across neurological practices. The Department of Neurology at NorthShore University HealthSystem (NorthShore) has built into its commercial EMR "Epic" structured clinical documentation support (SCDS) and clinical decision support (CDS) tools that standardize care, write progress notes, and capture up to 1,000 discreet and cascading fields of neurological data per office visit. However, these EMR tools have not been disseminated for use by other Neurology practices or for data sharing, and presently do not support clinical trials. Pragmatic trials using EMRs would enable comparisons of treatments at the point of care. To address gaps in quality improvement and practice based research in Neurology, we are proposing to the Agency for Healthcare Research and Quality (AHRQ) a project with the specific aims: 1) To create a Neurology Practice Based Research Network (NPBRN). The NorthShore site will share SCDS and CDS tools for 10 common neurological disorders (brain tumors, epilepsy, migraine, mild cognitive impairment, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson's disease, restless legs syndrome, and stroke) with seven other Department of Neurology that also use the Epic EMR platform (eight sites total). 2) To conduct at NorthShore pragmatic trials using the EMR for 10 common neurological disorders. We will demonstrate the feasibility of subgroup based adaptive assignment of treatments, electronic consenting, and outcomes data capture at the point of care using the EMR. We will identify the most effective treatments for common neurological disorders and seek replication by the NPBRN. Our aims are innovative because we will use the EMR to hardwire quality and outcomes research in Neurology. We will individualize medicine at the point of care by conducting pragmatic trials using subgroup based adaptive designs, comparing the effectiveness of available treatments for common neurological disorders. Our aims are significant because we are studying several neurological disorders, a leading cause of healthcare burden worldwide. We will create a national practice based network to improve health care quality by accelerating implementation of patient-centered outcomes research in Neurology using the EMR, and evidence to make health care safer and to improve health care efficiency.