Expanding Quality Care for Glaucoma through a Provider-Patient Partnership

描述（由申请人提供）：青光眼是美国失明和视力损害的主要原因，特别是在弱势群体中。尽管在NEI随机对照试验（RCT）中证明了可以由超过18，000名眼科医生和34，000名验光师提供的治疗方法，但对非MD提供者（如验光师）提供的青光眼护理的内容和质量几乎一无所知。在未来20年中，青光眼患者的数量预计将增加一倍以上，而眼科护理提供者的供应量增加不超过15%，因此，更好地支持验光师提供的慢性眼病（如青光眼）的适当和高质量护理的方法将变得与眼科医生中提高质量护理的技术一样重要。我们拟定的研究是一项以社区为基础的随机对照试验，旨在评估验光师和青光眼患者之间新型合作关系背景下基于技术（平板电脑）干预的适用性和有效性，以改善护理过程质量和最终护理结果。平板电脑将收集相关数据，向双方传达上下文适当的信息，然后根据美国验光协会（AOA）指南向患者和提供者提供关于当前就诊和未来护理步骤的反馈和建议。干预臂是基于现有技术的新应用，用于过去和当前研究中使用的患者和提供者，以及提高护理质量的创新方法。它扩大了电子医疗系统的使用范围，将患者纳入自己的护理范围。对照组将接受常规和习惯的继续专业教育（验光师）和标准患者教育材料（患者）。通过在新的应用中使用成功实施的技术，并在我们地区正在进行的以社区为基础的质量改进项目的成功基础上，这项研究提供了一种方法，如果干预成功，可以快速转化为社区护理。公共卫生相关性：如果成功，不仅研究方法能够直接用于青光眼护理，而且这些见解也适用于其他慢性眼病和任何其他慢性疾病。此外，这种技术将提供见解，以帮助非医生提供者在整个医疗保健中提供高质量的护理。

DESCRIPTION (provided by applicant): Glaucoma is a leading cause of blindness and visual impairment in the United States, particularly among disadvantaged populations. Despite the presence of therapies proven in NEI randomized controlled trials (RCT's) that can be delivered by more than 18,000 ophthalmologists and 34,000 optometrists, almost nothing is known about the content and quality of glaucoma care delivered by non-MD providers such as optometrists. With the numbers of people with glaucoma expected to more than double in the next twenty years in the face of no more than a 15% increase in the supply of eye care providers, methods to better support appropriate and high-quality care for chronic eye diseases such as glaucoma delivered by optometrists will become as critical, if not more so, as techniques to enhance quality care among ophthalmologists. Our proposed study is a community-based, randomized, controlled trial that evaluates the suitability and effectiveness of a technology-based (tablet computer) intervention within the context of a novel partnership between optometrists and patients with glaucoma to improve the process quality of care and ultimately outcomes of care. The tablet computer will collect relevant data, convey contextually appropriate information to both parties, and then provide feedback and recommendations to both the patient and the provider about the current visit and future steps in care, based on American Optometric Association (AOA) guidelines. The intervention arm is based on novel applications of existing technology for both patients and providers used in past and current studies and on innovative methods of enhancing quality of care. It expands the use of electronic health systems to include patients in their own care. A control group will be exposed to usual and customary continuing professional education (for the optometrists) and standard patient educational materials (for the patients). By using successfully implemented technology in novel applications, and by building on the success of ongoing community-based quality improvement projects in our region, the study provides a means for rapid translation into community care if the intervention is successful. Public Health Relevance: If successful, not only will the methods of the study be able to be directly implemented for glaucoma care but the insights should also be applicable to other chronic eye diseases and to any other chronic medical condition. Further, such techniques would provide insights to assist non-physician providers to provide high quality care throughout health care.