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接向远端地点提供医疗服务。近年来，远程医疗已扩展到包括各种远程提供的服务，包括生命体征监测、药物管理、“远程精神病学”等。远程医疗的利用率不断提高是由成本驱动的，而且对于偏远（“服务不足”）地区来说，缺乏专业人员来提供原本无法提供的服务。该提案旨在开发一种计算机化评估系统，能够对各种常用认知测试仪器以及行为精神测量（BPM）提供远程、基于音频视频的管理，就像检查者在现场一样。与接受评估的受试者面对面坐着。拟议的远程检查系统计算机化评估（CARES）将使合格的临床医生能够远程对研究对象或患有一系列后天性脑部疾病的患者进行彻底的神经心理学或精神病学评估，这些疾病通常适用于这些评估，包括：创伤性脑损伤、中风、脑肿瘤、神经毒理学损伤、艾滋病毒相关脑病、精神分裂症和阿尔茨海默病。偏远地点广泛包括农村和大都市地区医院、管理式医疗机构、团体诊所、疗养院、惩教机构、地区卫生诊所以及患者家中的临床评估单位。 CARES 将实施一种全新的方法，远程考官可以查看全屏、特定于应用程序的 GUI，该 GUI 提供屏幕控件，使考官能够：控制测试会话的速度、重复和补充计算机化指令、立即对口头报告或公开行为进行实时评分，并暂停或终止测试。因此，CARES 非常适合应用于通常需要持续监测和补充指导的受损人群。值得注意的是，CARES 是先前经过验证的双显示器计算机化评估系统的技术扩展，在该系统中，受试者由一名真人检查员陪同。该先行系统的 GUI 将适应托管高分辨率远程视频窗口，允许检查者和患者互相看到并交谈，建立高质量的“远程呈现”，这对于测试或 BPM 的管理尤其重要涉及主观印象或对明显行为的判断。因此，CARES 方法与现有的基于网络的评估形成鲜明对比，后者不仅没有审查员的陪同，而且还存在严格的管理程序以及多种技术缺陷，极大地限制了可以可靠管理的测试仪器的范围给有缺陷的个人。第二阶段的主要目标是： 1) 开发一个应用优化、标准化、移动 CARES 硬件平台（CHP），集成外围设备和软件实用程序； 2）比较伴随计算机化测试与远程计算机化测试的并发有效性、重测可靠性和用户可接受性。 CARES 将是同类系统中的第一个，并且可能会在一系列医疗保健服务网络、研究环境和对照临床试验中立即获得商业应用。 公共健康相关性：远程检查系统计算机化评估 (CARES) 是一项独特且高度创新的技术，旨在促进目前因地理或经济障碍而“服务不足”的地区提供基于电视的神经心理学和精神病学评估服务提供此类服务的经过适当培训的专业人员。这些服务不足的人群包括生活在农村地区或偏远地区（例如印第安人保留地）的个人、被监禁在惩教设施中的个人以及各种“居家”个人，例如不能走动的患者或疗养院的居民。当前项目希望解决一个紧迫的差距，即向这些患者提供原本无法提供的心理健康服务。