Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and Liver Cancer (CLOVER)

项目摘要 为了改善医疗保健和减少美国老龄人口的健康差距， 加州大学戴维斯分校（UCD）和加州大学欧文分校（UCI）合作提出 "加强电子健康系统，以减少结肠癌，肺癌，肥胖， 疫苗免疫性疾病和肝癌"（"三叶草"）。三叶草的总体目标是发展， 提供和传播基于电子卫生系统（EHR）的干预措施，以改善 通过增加对选定的美国预防服务工作队（USPSTF）等级的依从性， A级和B级建议以及疾病控制和预防中心（CDC）疫苗接种 建议.我们将通过试点（R61）和临床试验（R33）阶段使用 以下具体目标：目标#1（R61）：通过算法进行第一阶段行为干预开发 在ucd开发和测试epic healthy planet（hp），以识别有风险的患者，但从未进行过筛查 结肠癌或肺癌。目标#2（R61和R33）：利用增强的Epic HP，试点测试循证 在UCD和UCI定制干预措施，以提高结肠癌和肺癌筛查率的风险 个人10%。目标3（R61和R33）：通过评估患者确定"捆绑订购"的有效性 在他们进行初级保健访问以获得结肠癌和肺癌筛查、烟草和肥胖咨询的资格之前， 与单一程序相比，年龄适当的疫苗接种和丙型肝炎筛查节省了时间。 目标#4（R33）：通过将三叶草扩展到UCI，进行第四阶段行为干预开发 有联邦资格的健康中心目标5（R61和R33）：评价三叶草对增加 遵守选定的USPSTF建议，并减少人口统计群体的差异。 三叶草将巧妙地为Epic HP量身定制3项关键干预措施，并进行多中心传播， 增加上述筛查、咨询和疫苗接种：1）通过电子"批量信息"， UCD患者-医生门户网站使用由种族/民族引起共鸣的消息，2）“捆绑订购” 将由三叶草工作人员使用，以同时满足USPSTF和CDC建议中的缺陷。这 将包括使用新兴技术视频访问，患者将连接到认证烟草 和肥胖咨询师使用他们的智能手机，而不需要前往预约，和3）"定制 病人电子病历中的“健康维护”部分将提醒他们的PCP剩余的“护理缺口” 在USPSTF和CDC的建议，并促进共享决策的患者谁需要额外的 辅导如果这些目标得以实现，对USPSTF建议的遵守将得到加强， 为超过2.5亿患者提供服务的EHR公司将考虑将三叶草纳入其 基金会系统的所有组织考虑采用我们的方法。

PROJECT SUMMARY With the goal of improving medical care and reducing health disparities for the aging American population, the University of California, Davis (UCD) and University of California, Irvine (UCI) have collaborated to propose “Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and LivER Cancer” (“CLOVER”). The overall goal of CLOVER is to develop, deliver, and disseminate electronic health systems (EHR)-based interventions that will improve the well-being of older adults through increasing the adherence to selected US Preventive Services Task Force (USPSTF) Grade A and Grade B recommendations and Centers for Disease Control and Prevention (CDC) vaccination recommendations. We will accomplish this goal through pilot (R61) and clinical trial (R33) phases using the following Specific Aims: Aim #1 (R61): Conduct Stage I Behavioral Intervention Development by algorithm development and testing of Epic Healthy Planet (HP) at UCD to identify patients at risk, but never screened for colon cancer or lung cancer. Aim #2 (R61 and R33): Utilizing the enhanced Epic HP, pilot-test evidence-based and customized interventions at both UCD and UCI to increase colon and lung cancer screening rate for at-risk individuals by 10%. Aim #3 (R61 and R33): Determine effectiveness of “bundled ordering” by assessing patients prior to their primary care visit for eligibility for colon and lung cancer screening, tobacco and obesity counseling, age-appropriate vaccination, and hepatitis C screening compared to single procedures in terms of time-saved. Aim #4 (R33): Conduct Stage IV Behavioral Intervention Development by expansion of CLOVER to the UCI federally qualified health center. Aim #5 (R61 and R33): Evaluate the impact of CLOVER on increasing adherence to selected USPSTF recommendations and reducing their disparities by demographic group. CLOVER will cleverly tailor Epic HP to institute 3 key interventions with multi-centered dissemination which will increase the aforementioned screenings, counseling, and vaccinations: 1) Electronic “bulk messaging” through the UCD patient-physician portal using messages that resonate by racial/ethnic groups, 2) “Bundled ordering” will be used by CLOVER staff to fulfill deficiencies in USPSTF and CDC recommendations simultaneously. This will include the use of the emerging technology video visits by which patients will connect to certified tobacco and obesity counselors using their smart phones without the need to travel to an appointment, and 3) “Tailored Health Maintenance” section in the patient's electronic medical chart will alert their PCP of remaining “care gaps” in USPSTF and CDC recommendations and facilitate shared decision making for patients who need additional counseling. If these Aims are achieved, adherence to USPSTF recommendations will be enhanced, and Epic, the EHR company who serves more than 250 million patients will consider incorporating CLOVER into its Foundation System for all organizations to consider adopting our approach.