Improving Minority Health By Computer Detection Of Follow-up Failures

描述（由申请人提供）：本项目的总体目标是设计、测试和实施一个自动化系统，该系统可以监控医疗保健提供过程，以识别有生命危险的患者在后续护理中的潜在故障。检测结果异常和临床结果显示可能危及生命的患者没有得到随访，确诊的患者可能没有得到适当的初始治疗，而其他患者在获得可能额外的高质量生活所需的较长时间内没有得到适当的管理。在少数民族人群中，由于医生长期缺乏连续性，资源不足的提供者系统，与提供者的语言和文化交流差异，患者缺乏健康教育以及其他导致次优护理的压力因素，这些失败尤为突出。最初的重点是涉及指示肺癌的胸部x线检查结果异常以及前列腺癌筛查和诊断测试异常的病症；这些癌症在少数民族中更为普遍。平均而言，它们是在疾病的后期发现的，没有得到早期或广泛的干预。虽然导致更糟糕结果的个别失败可能发生在多个不同的点上，但一些最令人震惊的例子是：未能审查筛选测试的解释结果；未能建议/命令适当跟进异常测试结果或发现；以及未能发现次优治疗干预措施。美国CareLink （USCL）有限责任公司与波士顿医疗中心（新英格兰领先的安全网医院）及其HealthNet社区卫生中心合作，提议为市中心少数民族人口开发和演示一种名为TRACR（跟踪结果/发现、警报和临床反应）的计算机工具。作为一种护理监测工具，TRACR的设计超越了对忙碌的临床医生的简单提醒和提醒。它寻求在病人的一生中，在治疗疾病问题的关键过程中实现闭环。该系统积极识别护理过程中未解决的问题，通知临床医生和/或患者，并继续监测临床医生和患者的反应。在第一阶段，将开发底层软件技术，设计临床监测和随访规则，并在模拟环境中对系统进行测试。在第二阶段，将进行从最初的筛选到最初的全疗程治疗的TRACR问题检测和干预的实验现场试验。该制度将在全国一半的初级保健诊所和社区保健中心实施，并与接受“常规护理”的患者进行比较。如果证实可以解决这两个问题，TRACR可以应用于许多其他临床情况，其中发生随访失败，导致可避免的发病率和死亡率，特别是在少数民族人群中。其他可能的未来干预包括乳腺癌、结肠癌、糖尿病、骨质疏松症和高血压。公共卫生相关性：本项目拟开发的软件系统旨在改善各种临床条件下的护理随访。重点是那些临床条件和情况，不成比例地影响少数民族患者。该软件将异步监测患者的临床数据，当检测到需要随访的事件，但尚未执行随访操作时，该软件系统将联系医生或患者，或在适当情况下联系两者，以确保进行随访。

DESCRIPTION (provided by applicant): The overall objective of this project is to design, test and implement an automated system which monitors health care delivery processes to identify potential breakdowns in follow-up care for patients with life threatening conditions. Patients with abnormal tests and clinical findings, showing potentially life-threatening conditions, do not get follow-up, those diagnosed may not get appropriate initial treatment, and others are not properly managed over the extended periods of time necessary to gain the potential additional years of quality living. These failures are accentuated in minority populations because of lack of physician continuity over time, under-resourced provider systems, language and cultural communication differences with providers, lack of health education among patients, and other stressors which contribute to sub-optimal care. The initial focus is on conditions involving abnormal findings on chest x-ray indicative of lung cancers, and abnormal prostate cancer screening and diagnostic tests; these cancers are more prevalent among minorities. On average, they are discovered at later stages of disease and do not receive as early or extensive interventions. While individual failures leading to worse outcomes can occur at multiple different points, some of the most egregious examples are: failure to review interpreted results of screening tests; failure to recommend/order appropriate follow-up abnormal test results or findings; and failure to detect sub-optimal therapy interventions. US CareLink (USCL) LLC, in collaboration with Boston Medical Center (the leading safety net hospital in New England) and its HealthNet community health centers, proposes to develop and demonstrate, for inner-city minority populations, a computer-based tool called TRACR (Tracking Results/Findings, Alerts and Clinical Responses). As a care monitoring tool, TRACR is designed to go beyond simple reminders and alerts to busy clinicians. It seeks to close the loop in key processes of care for a disease problem longitudinally across a patient's lifetime. The system actively identifies unresolved actions in the care process, notifies clinicians and/or patients of these, and continues to monitor the response of the clinicians and patients. During Phase 1, the underlying software technology will be developed, the clinical rules for monitoring and follow-up will be designed, and the system tested in a simulated environment. In Phase 2, an experimental field trial of TRACR problem detection and intervention from initial screening through initial full course of therapy will be conducted. The system will be implemented for half of the primary care clinics and community health centers with comparison of rates of patients having proper follow-up care compared to those with "usual care." If proven for these two problems, TRACR can be applied to many other clinical conditions where follow-up failures occur, causing avoidable morbidity and mortality, particularly in minority populations. Other candidates for future intervention include breast cancer, colon cancer, diabetes, osteoporosis and hypertension. PUBLIC HEALTH RELEVANCE: The software system proposed to being developed under this project aims to improve the followup of care in a variety of clinical conditions. The emphasis is on those clinical conditions and scenarios that disproportionately affect minority patients. The software will monitor asynchronously patient's clinical data and when events requiring followup are detected, but the followup action has not been performed, the software system will contact the physician or the patient or both as appropriate to insure that followup occurs..