ED Disability Diagnostic Tool: An HIT Feasibility Study

ED 残疾诊断工具：HIT 可行性研究

• 批准号: 7984362
• 负责人: Lori Ann Post
• 金额: $ 49.85万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7984362
• 关键词: ED; Disability; Diagnostic; Tool; HIT

DESCRIPTION (provided by applicant): To improve health patient oriented outcomes in Emergency Departments (ED) by deriving, validating, and comparing the Rasch Disability Diagnostic Tool (RDDT) to existing Measure of Disability (MOD) Research Design: This multi methodological study includes deriving a Rasch scale of disability: I) Using the RDDT to retrospectively score disability indicators, validating the RDDT, selecting a subset of the Rasch scale to be used as a brief measure for an ED randomized clinical trial; II) Prospectively, linking disability assessments to patient oriented outcomes (health care service utilization and mortality). This study would compare diagnoses to determine impact on patient outcomes and costs. Methodology: An expert panel would determine content for the disability diagnostic tool, Rasch scales would be created to score disability in existing hospital records in the retrospective phase. First, we would retrieve all disability assessments performed on ED patients (20-30 per day) since the inception of the electronic data collection system at Yale New Haven Hospital (April 2005). Second, we would score disability in ED records for patients > 65 years and examine patient outcomes, treatments and referrals based on the assessment. Third, we would examine how the assessment impacted ED patient oriented outcomes. The retrospective phase of this study would allow us to track subsequent Yale hospital and ED visits, treatments, and health outcomes. A brief accurate and precise RDDT, developed in the retrospective analysis would be used for the prospective phase to compare with the existing MOD in a randomized clinical trial. 600 patients would be recruited over the course of the study and randomly allocated into the MOD (control) or RDDT (test) arm. Consented study subjects, including ED patients, families, and patient health care providers would be followed for two months. The primary patient outcomes, ED visits, hospital admits, and mortality would be quantified for comparative purposes. We would estimate the number of preventable ED visits and hospitalizations and provide a cost benefit for adopting the RDDT in EDs. Finally, the RDDT would rely on health information technology. The exploratory aim of the study would assess work flow, time and cost savings, efficiency and usability for use in the ED. Potential Impact on Health Outcomes: We expect that a better disability diagnostic tool would lead to lower mortality, a reduction in unnecessary costs, preventable ED visits and hospitalizations, and a better quality of life for patients presenting to Emergency Departments. PUBLIC HEALTH RELEVANCE: Increasing numbers of elderly and/or disabled persons are presenting to Emergency Departments (ED) that require an assessment of their disabilities for treatment and proper referral. ED physicians are often at a loss because these patients do not require acute care or hospitalization yet their failure to thrive in the community brings them repeatedly to the ED where their needs are not being met. This study aims to improve the health outcomes of persons presenting to EDs by developing and validating a disability diagnostic tool that would allow ED physicians to connect these patients to better health care referrals, proper long term care services, and other non-ED health care providers.

描述（由申请人提供）：通过推导、验证 Rasch 残疾诊断工具 (RDDT) 与现有残疾测量 (MOD) 并进行比较，改善急诊科 (ED) 以健康患者为导向的结果 研究设计：这项多方法研究包括推导 Rasch 残疾量表： I) 使用 RDDT 回顾性评分残疾指标，验证 RDDT，选择 Rasch 量表的子集用作 ED 随机临床的简要测量 审判; II) 前瞻性地将残疾评估与以患者为导向的结果（医疗保健服务利用和死亡率）联系起来。这项研究将比较诊断以确定对患者结果和费用的影响。方法：专家小组将确定残疾诊断工具的内容，将创建拉希量表，以便在回顾阶段对现有医院记录中的残疾进行评分。首先，我们将检索自耶鲁纽黑文医院电子数据收集系统启动（2005 年 4 月）以来对 ED 患者进行的所有残疾评估（每天 20-30 次）。其次，我们会对 65 岁以上患者的急诊记录中的残疾进行评分，并根据评估检查患者的治疗结果、治疗和转诊。第三，我们将研究评估如何影响以急诊患者为导向的结果。这项研究的回顾阶段将使我们能够跟踪随后的耶鲁医院和急诊室就诊、治疗和健康结果。在回顾性分析中开发的简短、准确和精确的 RDDT 将用于前瞻性阶段，以与随机临床试验中现有的 MOD 进行比较。在研究过程中将招募 600 名患者，并随机分配到 MOD（对照）组或 RDDT（测试）组。同意的研究对象，包括急诊室患者、家属和患者医疗保健提供者，将被跟踪两个月。出于比较目的，将对患者的主要结果、急诊就诊、入院和死亡率进行量化。我们将估计可预防的急诊就诊和住院次数，并提供在急诊科采用 RDDT 的成本效益。最后，RDDT 将依赖于卫生信息技术。该研究的探索性目的是评估急诊科的工作流程、时间和成本节省、效率和可用性。对健康结果的潜在影响：我们预计更好的残疾诊断工具将降低死亡率、减少不必要的费用、可预防的急诊就诊和住院治疗，以及提高急诊科患者的生活质量。 公共卫生相关性：越来越多的老年人和/或残疾人到急诊科 (ED) 就诊，要求对其残疾情况进行评估，以进行治疗和适当转诊。急诊科医生常常不知所措，因为这些患者不需要紧急护理或住院治疗，但他们在社区中的成长失败使他们反复来到急诊室，但他们的需求得不到满足。本研究旨在通过开发和验证残疾诊断工具来改善就诊于急诊室的患者的健康状况，该工具将使急诊室医生能够将这些患者与更好的医疗保健转诊、适当的长期护理服务和其他非急诊医疗保健提供者联系起来。