Computerized Assessment by Remote Examiner System (CARES)

远程检查系统计算机化评估（CARES）

• 批准号: 7913133
• 负责人: JAMES P O'HALLORAN
• 金额: $ 53.94万
• 依托单位: NEUROCOMP SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-02-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7913133
• 关键词: Address; Alzheimer' s Disease; Area; Behavior; Behavioral; Brain Diseases; Brain Neoplasms; Businesses; Clinic; Clinical Data; Clinical Research; Clinical Trials; Cognitive; Complex; Computer Systems Development; Computer software; Computerized Medical Record; Computers; Controlled Clinical Trials; Data; Development; Devices; Discipline of Nursing; Distal; Economics; Electronics; Ensure; Evaluation; Evaluation Research; Foundations; Goals; Group Practice; Health; Healthcare Systems; Home environment; Hospitals; Human; Imprisonment; Indian reservation; Individual; Instruction; Interview; Judgment; Left; Life; Location; Logic; Managed Care; Measures; Medication Management; Mental Health Services; Monitor; Neurocognitive; Nursing Homes; Online Systems; Patients; Performance; Peripheral; Phase; Population; Procedures; Psychometrics; Qualifying; Reporting; Research; Research Infrastructure; Research Subjects; Resolution; Running; Rural; Schedule; Schizophrenia; Services; Side; Site; Solutions; Standardization; Stroke; System; Telemedicine; Testing; Time; Training; Traumatic Brain Injury; Underserved Population; Visit; base; behavior measurement; clinical research site; commercial application; computerized; cost; data format; data management; design; field study; health care delivery; impression; innovation; innovative technologies; instrument; interoperability; meetings; metropolitan; neuropsychological; novel; novel strategies; public health relevance; research clinical testing; response; rural area; wireless network

DESCRIPTION (provided by applicant): Telemedicine can be defined as the delivery of healthcare services to distal locations by electronic connectivity. In recent years, telemedicine has expanded to include a wide range of remotely delivered services, including vital signs monitoring, medication management, "telepsychiatry" and others. The increasing utilization of telemedicine is driven by cost and, for distal ("underserved") regions, a lack of professionals to deliver otherwise unavailable services. This proposal aims to develop a computerized assessment system capable of providing remote, audio-video-based administration of a wide range of commonly applied cognitive test instruments as well as behavioral-psychiatric measures (BPMs), in a similar manner as if the examiner were sitting face-to-face with the subject being evaluated. The proposed Computerized Assessment by Remote Examiner System (CARES) will enable qualified clinicians to remotely conduct thorough neuropsychological or psychiatric evaluations of research subjects or patients with a range of acquired brain disorders for which such assessments are routinely applied, including: traumatic brain injury, stroke, brain tumor, neurotoxicologicalinsult,HIV-relatedencephalopathy,schizophrenia,and Alzheimer's disease. Remote locations broadly include clinical evaluation units at hospitals, managed care facilities, group practice sites, nursing homes, correctional facilities, regional health clinics, and in patient's homes, in both rural and metropolitan areas. The CARES will implement a fundamentally new approach in which a remote examiner views a full-screen, application-specific GUI that provides on- screen controls that will enable an examiner to: control the pace of the test session, repeat and supplement computerized instructions, immediately score verbal report or overt behavior in real time, and pause or terminate a test. Thus, the CARES is well suited for application in impaired populations that commonly require ongoing monitoring and supplemental instruction. Significantly, the CARES is a technological extension of a previously validated, dual-display, computerized assessment system in which the subject is physically accompanied by a human examiner. The GUI for this antecedent system will be adapted to host a high-resolution televideo window that permits an examiner and patient to see and talk to each other, establishing high-quality "telepresence", which is especially important for the administration of tests or BPMs involving subjective impressions or judgement of overt behavior. Accordingly, the CARES approach contrasts sharply with available, web-based assessments that are not only unaccompanied by an examiner, but suffer from rigid administration procedures, as well as multiple technical shortcomings, that significantly limit the range of test instruments that can be reliably administered to impaired individuals. In Phase II, the main objectives are to: 1) develop an application- optimized, standardized, mobile CARES Hardware Platform (CHP) with integrated peripheral devices and software utilities; and 2)compare the concurrent validity, test-retest reliability, and user acceptability of accompanied computerized testing vs. remote computerized testing. The CARES will be the first system of its kind and will likely find immediate commercial application across a range of healthcare delivery networks, research settings, and controlled clinical trials. PUBLIC HEALTH RELEVANCE: The Computerized Assessment by Remote Examiner System (CARES) is a unique and highly innovative technology intended to facilitate televideo-based neuropsychological and psychiatric evaluation services in areas that are currently "underserved" due to either geographic or economic obstacles that limit access to properly trained professionals who provide such services. Among these underserved populations are individuals living in rural areas or remote regions such as Indian reservations, individuals incarcerated in correctional facilities, and a variety of "homebound" individuals such as non-ambulatory patients or residents of nursing homes. The need to provide otherwise unavailable mental health services to these patients is a pressing disparity that the current project hopes to address.

描述（由申请人提供）：远程医疗可以定义为通过电子连通性向远端位置提供医疗服务。近年来，远程医疗已扩展到包括各种远程交付的服务，包括生命体征监测，药物管理，“远程精神病学”等。远程医疗的利用日益增加是由成本驱动的，对于远端（“服务欠缺”）地区，缺乏专业人员来提供原本无法获得的服务。该提案旨在开发一个计算机化评估系统，能够以类似的方式提供基于远程的，基于音频视频的管理系统，对广泛应用的常用认知测试工具以及行为精神疾病措施（BPMS）（BPMS），就像审查员与受试者面对面坐着相似。 The proposed Computerized Assessment by Remote Examiner System (CARES) will enable qualified clinicians to remotely conduct thorough neuropsychological or psychiatric evaluations of research subjects or patients with a range of acquired brain disorders for which such assessments are routinely applied, including: traumatic brain injury, stroke, brain tumor, neurotoxicologicalinsult,HIV-relatedencephalopathy,schizophrenia,and阿尔茨海默氏病。偏远地区广泛包括医院的临床评估单位，托管护理设施，小组练习现场，疗养院，惩教设施，区域卫生诊所以及在农村和大都市地区的患者家中。 CARES将实施一种从根本上进行新的方法，在该方法中，远程检查员观看了一个全屏，特定于应用程序的GUI，该GUI提供了屏幕控件，该控件将使审查员能够：控制测试会话的速度，重复和补充计算机说明，立即在实时进行口头报告或公开的行为，并在实时进行言语报告或终止测试或终止测试。因此，护理非常适合在受损的人群中应用，这些人口通常需要进行持续的监测和补充指导。值得注意的是，护理是先前验证的，双显示的计算机评估系统的技术扩展，在该系统中，受试者在人体上伴有人类检查员。该先行系统的GUI将适应一个高分辨率的Televideo窗口，该窗口允许审查员和患者互相看见和交谈，建立高质量的“远程敏感”，这对于涉及主观印象或公开行为的测试或BPM尤其重要。因此，CARES方法与可用的基于Web的评估形成鲜明对比，这些评估不仅是由审查员陪伴的，而且遭受了严格的管理程序以及多个技术缺陷的困扰，这些缺点大大限制了可以可靠地管理的测试工具的范围。在第二阶段中，主要目标是：1）开发具有集成的外围设备和软件实用程序的应用程序优化，标准化的移动护理硬件平台（CHP）； 2）比较随附的计算机测试与远程计算机测试的并发有效性，重测信度以及用户的可接受性。护理将是同类系统的第一个系统，很可能会在一系列医疗保健交付网络，研究环境和对照临床试验中找到立即的商业应用。 公共卫生相关性：远程考官系统（CARES）进行的计算机评估是一项独特且高度创新的技术，旨在促进基于电视的神经心理学和精神病学评估服务，目前由于限制了对提供此类服务的经过适当训练的专业人士的访问，目前“服务不足”的领域。在这些服务不足的人群中，包括居住在农村地区或偏远地区的个人，例如印度保留地，被监禁在惩教设施中的人以及各种“家里”个体，例如非卧室患者或养老院的居民。为这些患者提供其他不可用的心理健康服务的需求是当前项目希望解决的紧迫差距。