Enhancing Guidelines with Collaborative Care Agents

描述(由申请人提供)： 这项拟议研究的目的是通过协作护理代理和计算机支持的指南来增强协作护理模式，从而改善临床护理。具体地说，我们研究护理经理-直接参与创建患者特定护理计划并与其他提供者沟通的临床专业人员-作为协作护理代理在实施信息系统倡议(如计算机支持的指南)方面的贡献。护理经理特别适合在此类活动中提供帮助，因为他们使用参与性、协作性的决策来创建针对患者的护理计划。因此，他们解决了计算机支持的指南的一个关键失败：无法从通常僵化的指南努力中制定出患者特定的、灵活的计划。研究将包括几个阶段：信息需求评估和概念图；由护理管理者制定和调整指南；以及评估已实施的指南。使用定性和定量方法，将进行对照试验，以评估护理经理参与确保实施成功的关键方面。考虑的结果将是满意度、感知的好处、患者的依从性和预计的发病率，以及大型卫生系统中护理管理者的预期成本效益。将根据护理管理的主要已知益处建立一个质量改进框架，以进一步协助制定和执行计算机支持的准则。这项拟议的研究不仅将加深我们对协作护理模型和信息系统倡议的理解，而且还将加深我们对协作护理代理的关键作用的理解--致力于帮助实现协作护理模式和计算机支持的指南的好处的人。

DESCRIPTION (provided by applicant): The purpose of this proposed research is to improve clinical care by enhancing collaborative care models through collaborative care agents and computer-supported guidelines. Specifically, we study the contribution of care managers - clinical professionals directly involved with creating patient specific care plans and communicating with other providers - as collaborative care agents in the implementation of information system initiatives such as computer-supported guidelines. Care managers are uniquely suited to aid in such initiatives, since they use participative, collaborative decision-making to create patient-specific care plans. Thus, they address a key failure of computer-supported guidelines: the inability to make patient specific, flexible plans from often inflexible guideline efforts. The research will consist of several stages: information need assessment and concept mapping; guideline creation by and adjustment for care managers; and evaluation of implemented guidelines. Using qualitative and quantitative methods, a controlled trial will be performed to assess the key aspects of care manager involvement in assuring implementation success. Outcomes considered will be satisfaction, perceived benefits, patient adherence and projected morbidity, and projected cost-effectiveness of care managers within a large health system. A quality improvement framework will be constructed from the key perceived benefits of care management to further aid in development and implementation of computer-supported guidelines. This proposed research will further our understanding not only of collaborative care models and information systems initiative, but also improve our understanding of the crucial role of collaborative care agents - dedicated people who help achieve the benefits of both collaborative care models and computer-supported guidelines.