Web Triage as a Critical Patient Portal Function: RCT for Safety and Cost-Savings

Web 分诊作为关键患者门户功能：用于安全和节省成本的 RCT

基本信息

批准号：
8124243
负责人：
Javed Mostafa
金额：
$ 14.98万
依托单位：
KEONA HEALTH, INC.
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-07-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8124243
关键词：
Achievement Acute Adoption Award Biometry Caregivers Caring Categories Client satisfaction Clinical Clinical Decision Support Systems Clinical Sciences Clinical Trials Communities Computerized Medical Record Consultations Cost Savings Disease Emergency Care Emergency treatment Fees Goals Health Personnel Health Services Healthcare Home environment Influenza Information Systems Institutes Insurance Internet Lead Left Measures Medical Records Monitor North Carolina Nurses Online Systems Patient Care Patients Physicians Population Primary Care Physician Primary Health Care Process Protocols documentation Provider Randomized Controlled Trials Recommendation Records Research Research Personnel Research Project Grants Risk Running Safety Savings Self Care Services Sexually Transmitted Diseases Solutions Students System Techniques Technology Telephone Testing Time Translational Research Treatment Cost Triage Universities Upper Respiratory Infections Urinary tract infection Visit alternative treatment cost experience follow-up improved innovation open source patient safety prevent

项目摘要

DESCRIPTION (provided by applicant): Studies of patient triage in selected populations found significant numbers of patients needing either a more or a less acute level of care, and that 47%-58% of ED visits were considered inappropriate by triage nurses and physicians. Contributing to this problem is lack of accessibility and responsiveness of services to determine the appropriate level of care. In one study, 62% of patients could not reach their primary care physician before going to the ER. Telephone triage has been proposed as one solution, but lack of reimbursement and the high cost of nurse time have prevented telephone triage from widespread implementation. Web triage systems use the same protocols as telephone triage, but patients can answer the questions over the web and receive recommendations through a web-based Clinical Decision Support (CDS) system, greatly reducing costs. Though existing research on web triage systems have shown promise, including good congruence with nurse recommendations and high patient satisfaction, there is a need to measure the safety and cost-savings of this approach before it can be widely deployed. A retrospective analysis of 1,500 patient records in partnership with Campus Health Services (CHS) at the University of North Carolina at Chapel Hill has found the potential to save $300,000 per year. The goals of the proposed project are to implement, test, and verify safety and cost-savings, of a web-based CDS triage system. Innovative, new features to improve safety and cost savings, including integration with electronic medical records, the Patient Portal, and the triage nurse's workflow, and include comprehensive quality management techniques, will be added to the current system. A randomized controlled trial with CHS measuring safety and cost savings of web triage versus current practice will be conducted. The savings accrued with the proposed system could be returned to students through reduced fees or other services. Successful achievement of this project could lead to a CDS system with large commercial potential -- saving millions of dollars for insurance companies, and providing improved patient safety, more appropriate care, and lower costs for consumers. PUBLIC HEALTH RELEVANCE: Our web triage system uses Clinical Decision Support (CDS) to recommend patients an appropriate level of care, urgency, and even articles on self-care options over the web. This system has the potential to make significant improvements to the delivery and management of primary and emergency care, including improved responsiveness, patient safety, identifying lower cost care alternatives, and reducing insurance premiums for consumers. We plan to run a randomized controlled trial (RCT) to better understand the safety and cost savings of web triage, which remain as two barriers to adoption of this technology in the general community.

描述（由申请人提供）：对选定人群中的患者分诊研究发现，大量患者需要或多或少的急性护理，并且分诊护士和医生认为 47%-58% 的急诊就诊是不适当的。造成这一问题的原因是缺乏确定适当护理水平的服务的可及性和响应能力。在一项研究中，62% 的患者在前往急诊室之前无法联系到他们的初级保健医生。电话分诊已被提议作为一种解决方案，但缺乏报销和护士时间成本高昂阻碍了电话分诊的广泛实施。网络分诊系统使用与电话分诊相同的协议，但患者可以通过网络回答问题并通过基于网络的临床决策支持（CDS）系统接收建议，从而大大降低了成本。尽管现有的网络分诊系统研究已显示出希望，包括与护士建议的良好一致性和患者的高满意度，但在广泛部署之前，需要衡量这种方法的安全性和成本节约。与北卡罗来纳大学教堂山分校校园健康服务中心 (CHS) 合作对 1,500 份患者记录进行回顾性分析，发现每年可以节省 300,000 美元。拟议项目的目标是实施、测试和验证基于网络的 CDS 分类系统的安全性和成本节约。现有系统将添加创新的新功能，以提高安全性并节省成本，包括与电子病历、患者门户和分诊护士工作流程的集成，以及全面的质量管理技术。将使用 CHS 进行一项随机对照试验，衡量网络分类与当前实践的安全性和成本节省情况。拟议系统产生的节省可以通过降低费用或其他服务返还给学生。该项目的成功实现可能会带来具有巨大商业潜力的 CDS 系统——为保险公司节省数百万美元，并为消费者提供更好的患者安全、更适当的护理和更低的成本。公共健康相关性：我们的网络分诊系统使用临床决策支持 (CDS) 向患者推荐适当级别的护理、紧急情况，甚至在网络上推荐有关自我护理选项的文章。该系统有可能显着改善初级和紧急护理的提供和管理，包括提高响应能力、患者安全、确定成本更低的护理替代方案以及降低消费者的保险费。我们计划进行一项随机对照试验 (RCT)，以更好地了解网络分类的安全性和成本节约，这仍然是普通社区采用该技术的两个障碍。