PRIS-M: Precision Monitoring to Transform Care

PRIS-M：精准监测以改变护理方式

• 批准号: 10308563
• 负责人: Dawn Marie Bravata
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308563
• 关键词: Accident and Emergency department; Address; Area; Automobile Driving; Behavior; Caring; Clinical; Clinical Pathways; Clinical Research; Collaborations; Custom; Data; Data Analyses; Data Collection; Data Sources; Decision Making; Development; Diagnostic tests; Disease; Documentation; Electronic Health Record; Engineering; Evaluation; Evidence based intervention; Genetic; Goals; Health Promotion; Healthcare; Healthcare Systems; Individual; Information Systems; Information Technology; Inpatients; Intensive Care Units; Knowledge; Lead; Leadership; Link; Measures; Medical Care Team; Medicine; Methods; Modeling; Monitor; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Persons; Prevention strategy; Provider; Quality of Care; Recording of previous events; Reporting; Research; Right to Treatments; Risk; Service delivery model; Sleep Apnea Syndromes; Source; Standardization; Structure; System; Testing; Time; Transient Ischemic Attack; Ultrasonography; Veterans; Veterans Health Administration; Work; acute stroke; adverse outcome; base; behavior change; behavior influence; cancer diagnosis; care outcomes; clinical care; contextual factors; data infrastructure; data warehouse; disorder prevention; electronic data; experience; genetic information; health care delivery; health care settings; health data; implementation measures; implementation strategy; improved; improved outcome; individual patient; individual variation; innovation; medical specialties; point of care; population health; precision medicine; programs; satisfaction; support tools; telehealth; tool; treatment strategy; unstructured data; usability

 DESCRIPTION (provided by applicant): Background and Specific Aims The VHA is unquestionably a leader in use of electronic health record (EHR) data to inform clinical, operational, and administrative decisions. Despite the growing granularity and accessibility of these data, however, data are currently most commonly used to retrospectively evaluate quality of care rather than to provide the right data at the right time to the right person in a way that increases patient and staff satisfaction and improves healthcare outcomes. The Precision Monitoring (PRIS-M) to Transform Care program meets this critical need as it aims to: 1) Implement and evaluate electronic clinical quality measures (eCQMs) and decision support tools at the point of care; 2) Conduct scalable clinical quality improvement projects that link electronic data to provider actions and reporting; 3) Investigate the effects of providing actionable EHR-based data on care team and Veteran behaviors and satisfaction; and 4) Identify the implementation strategies and contextual factors that activate VHA providers, leaders, and Veterans to use data to transform care. Methods With the ongoing input of our core partners, these aims will be accomplished via core research and quality improvement projects that cover multiple conditions and care settings. Our projects focus on: 1) national implementation of inpatient eCQMs, 2) testing telehealth modules and eCQMs for improving rapid transient ischemic attack (TIA) care, 3) decision support to deimplement inappropriate carotid ultrasound image ordering, and 4) a local quality improvement project to implement and evaluate a remote sleep apnea monitoring program. In addition, the PRIS-M program includes two additional projects: one to implement and evaluate the first Emergency Department Clinical Pathway decision support tool (acute stroke care) being rolled out to facilities in January 2016, and one to implement a local program of electronic documentation and display of patient behavior change goals to improve coordination and satisfaction with care. These projects are supported by an Implementation and Data Core that works across all projects to facilitate efficient use of data; usability testing of new tools; and standardized use f implementation measures, methods, and analytic approaches. Our overarching implementation strategy focuses on activating individuals and groups to use data to transform care, and we use the CFIR framework to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact how people use data to transform care. Key partners include OIA/OABI, the Office of Specialty Care, the National Center for Health Promotion and Disease Prevention, the Office of Telehealth, the Roudebush VAMC, and the VA Center for Applied Systems Engineering. Anticipated impacts The PRIS-M Program directly addresses the Blueprint for Excellence Strategy Three: Leverage information technologies, analytics, and models of healthcare delivery to optimize individual and population health outcomes. Our projects lead directly to the implementation and evaluation of tools that will be useful across all VHA facilities and multiple clinical conditions and settings. We also wil address the important implementation questions about how best to use data to activate providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes. In total, this program will provide multiple new proven tools and strategies for VHA to use as it leads the nation in leveraging its data systems to transform care.

 描述（由申请人提供）： 背景和具体目标 VHA 毫无疑问是使用电子健康记录 (EHR) 数据为临床、操作和管理决策提供信息的领导者，尽管这些数据的数量和可访问性不断增加，但目前最常用于回顾性数据。评估护理质量，而不是在正确的位置提供正确的数据 以提高患者和员工满意度并改善医疗保健结果的方式将时间交给合适的人，精准监测 (PRIS-M) 转变护理计划满足了这一关键需求，因为它的目标是： 1) 实施和评估电子临床质量措施（ eCQM）和护理点决策支持工具； 2）开展可扩展的临床质量改进项目，将电子数据与提供者的行动和报告联系起来； 3）研究提供基于 EHR 的可操作数据对护理团队和退伍军人行为的影响；满意度；4) 确定实施策略和背景因素，促使 VHA 提供者、领导者和退伍军人使用数据来转变护理方法。在我们核心合作伙伴的持续投入下，这些目标将通过核心研究和质量改进项目来实现。我们的项目重点关注：1) 住院患者 eCQM 的全国实施，2) 测试远程医疗模块和 eCQM，以改善快速短暂性脑缺血发作 (TIA) 护理，3) 消除不当行为的决策支持。颈动脉超声图像订购，以及 4) 实施和评估远程睡眠呼吸暂停监测计划的本地质量改进项目 此外，PRIS-M 计划还包括两个额外项目：一个实施和评估第一个急诊科临床路径决策支持。 2016 年 1 月在各机构推出了一个工具（急性中风护理），还有一个用于实施本地电子文档计划并显示患者行为改变目标，以提高护理的协调性和满意度。这些项目得到了实施和数据核心的支持。适用于所有促进数据有效利用的项目；新工具的可用性测试；以及实施措施、方法和分析方法的标准化使用。规划跨项目的数据收集和分析，以确定影响人们如何使用数据转变护理的核心实施策略和背景因素 主要合作伙伴包括 OIA/OABI、专业护理办公室、国家健康促进和疾病预防中心、远程医疗办公室Roudebush VAMC 和 VA 应用系统工程中心 预期影响 PRIS-M 计划直接解决卓越战略蓝图三：利用信息技术、分析和医疗保健服务模式来优化个人和人口健康结果。我们还将解决有关如何最好地利用数据来激活提供者、医疗团队和退伍军人以改善医疗服务的重要实施问题。和结果。总的来说，该计划将为 VHA 提供多种经过验证的新工具和策略，以供 VHA 使用，因为 VHA 在利用其数据系统来转变护理方面处于领先地位。

项目成果

A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

一项整群随机质量改进研究，旨在改善两项住院患者中风质量指标。

• DOI: 10.1136/bmjqs-2015-004188
• 发表时间: 2016
• 期刊: BMJ quality & safety
• 影响因子: 5.4
• 作者: Williams,Linda;Daggett,Virginia;Slaven,JamesE;Yu,Zhangsheng;Sager,Danielle;Myers,Jennifer;Plue,Laurie;Woodward-Hagg,Heather;Damush,TeresaM
• 通讯作者: Damush,TeresaM

Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence.

• DOI: 10.1161/strokeaha.120.031721
• 发表时间: 2021-07
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Levine DA;Perkins AJ;Sico JJ;Myers LJ;Phipps MS;Zhang Y;Bravata DM
• 通讯作者: Bravata DM

Active and receptive arts participation and their association with mortality among adults in the United States: a longitudinal cohort study.

积极和接受的艺术参与及其与美国成年人死亡率的关系：一项纵向队列研究。

• DOI: 10.1016/j.puhe.2021.05.034
• 发表时间: 2021
• 期刊: Public health
• 影响因子: 5.2
• 作者: Story,KristinM;Yang,Ziyi;Bravata,DawnM
• 通讯作者: Bravata,DawnM

Trends in Preventative Health Services for Veterans with Military Coverage Compared to Non-Military Coverage.

与非军事保险相比，军事保险退伍军人预防性医疗服务的趋势。

• DOI: 10.1007/s11606-019-05377-w
• 发表时间: 2020
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Tummalapalli,SriLekha;Keyhani,Salomeh
• 通讯作者: Keyhani,Salomeh

A telehealth-based randomized controlled trial: A model for outpatient trials of off-label medications during the COVID-19 pandemic.

• DOI: 10.1177/17407745211011577
• 发表时间: 2021-08
• 期刊: Clinical trials (London, England)
• 作者: Keyhani S;Kelly JD;Bent S;Boscardin WJ;Shlipak MG;Leonard S;Abraham A;Lum E;Lau N;Austin C;Oldenburg CE;Zillich A;Lopez L;Zhang Y;Lietman T;Bravata DM
• 通讯作者: Bravata DM