Web System for Engaging Families & Doctors in Continuous Asthma Quality Improveme

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• 批准号: 8620375
• 负责人: Barbara Jo Howard
• 金额: $ 50.66万
• 依托单位: TOTAL CHILD HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8620375
• 关键词: Accreditation; Address; Adherence; Affect; Algorithms; Appointment; Asthma; Books; Caring; Certification; Cessation of life; Child; Childhood Asthma; Clinical; Cognitive; Communication; Consensus; Counseling; Data; Decision Support Systems; Dimensions; Documentation; Educational Activities; Effectiveness; Electronic Mail; Failure; Family; Feedback; Group Processes; Guidelines; Home environment; Hospitalization; Internet; Intervention; Intervention Studies; Intervention Trial; Interview; Low income; Maintenance; Manuals; Maps; Marketing; Measurement; Medical; Memory; Minority; Modeling; Monitor; Online Systems; Outcome; Parenting Education; Parents; Patient Education; Patient Participation; Patients; Performance; Phase; Primary Care Physician; Primary Health Care; Problem Solving; Psychological reinforcement; Quality of Care; Questionnaires; Randomized; Reporting; Research Personnel; Running; Sampling; Schools; Services; Severities; Specialty Boards; Symptoms; System; Telephone; Testing; Time; Training; Variant; Visit; antibiotic I-11; base; compliance behavior; demographics; design; health care delivery; improved; innovation; instrument; medical specialties; parallel processing; programs; web site

DESCRIPTION (provided by applicant): Asthma affects 8% of US children and is a leading cause of ED visits, hospitalization, missed school, suffering and death. It disproportionately affects low income minorities. This proposal seeks to overcome health care delivery barriers to implementation of national asthma guidelines - both clinician failures to provide guideline based care and patient adherence when appropriate treatments are offered. This project will develop and then test effectiveness of an innovative web-based decision support system (CHADIS) to support teaming doctors and patients in parallel processes of continuous quality improvement of asthma care for doctors and engagement of parents and children in their own care. CHADIS engages parents in completing pre-visit questionnaires, which trigger patient specific decision support for doctors for use in the visit. Patients will complete the Pediatric Asthma Control & Communication Instrument (PACCI), a questionnaire of asthma symptoms recently validated across a range of demographics by one of the co-investigators, online via CHADIS pre-visit and between visits. Doctor interaction with CHADIS decision support during the visit results in both documentation for recertification credit and triggering of individualized parent education to appear in an enticing website for each child called the Memory Book/Care Portal. Patient adherence is addressed through Problem Solving Counseling by the clinician prompted by the pre-visit data on symptoms and barriers. Patients also are provided tailored default messages and alerts in the Care Portal which can also be monitored by a remote coach. Monitoring of asthma symptoms between visits is expected and CHADIS uses multiple forms of automated communication (texting, email, and phone) to prompt completion of the PACCI. In addition, parents are encouraged to do questionnaires through multimodal reinforcements including: the Memory Book, coupons for free products and "gamification" i.e. entertaining videos and quiz games for individualized patient education. In Phase I the system is built with professional and patient feedback and piloting and presented to medical specialty boards for formal QI MOC certification. In Phase II the system is further refined and then tested for effectiveness in improving asthma control by a large intervention study using a cluster randomized control design. The Phase III product will have market value as it improves and documents care for Quality Improvement, Maintenance of Certification credit, meaningful use, clinical quality measurement, pay for performance and Medical Home efforts.

描述（由申请人提供）：哮喘影响 8% 的美国儿童，是导致急诊就诊、住院、缺课、痛苦和死亡的主要原因。它对低收入少数群体的影响尤为严重。该提案旨在克服实施国家哮喘指南的医疗保健提供障碍——临床医生未能提供基于指南的护理，以及患者在提供适当治疗时的依从性。该项目将开发并测试基于网络的创新决策支持系统 (CHADIS) 的有效性，以支持医生和患者在并行过程中进行团队合作，不断提高医生的哮喘护理质量以及家长和儿童参与自己的护理。 CHADIS 让家长填写就诊前调查问卷，从而为医生在就诊时提供患者特定的决策支持。患者将在就诊前和就诊期间通过 CHADIS 在线完成儿科哮喘控制和沟通工具 (PACCI)，这是一份最近由一位联合研究者在一系列人口统计数据中验证的哮喘症状调查问卷。就诊期间，医生与 CHADIS 决策支持的互动会产生重新认证学分的文件，并触发个性化的家长教育，这些文件会出现在一个名为“记忆簿/护理门户”的诱人网站上，为每个孩子提供服务。临床医生根据就诊前的症状和障碍数据提示，通过问题解决咨询来解决患者的依从性。患者还可以在护理门户中获得定制的默认消息和警报，也可以由远程教练进行监控。预计会在就诊之间监测哮喘症状，CHADIS 使用多种形式的自动通信（短信、电子邮件和电话）来提示完成 PACCI。此外，鼓励家长通过多模式强化进行问卷调查，包括：记忆簿、免费产品优惠券和“游戏化”，即用于个性化患者教育的娱乐视频和问答游戏。在第一阶段，该系统根据专业和患者的反馈和试点进行构建，并提交给医学专业委员会进行正式的 QI MOC 认证。在第二阶段，该系统被进一步完善，然后通过使用集群随机控制设计的大型干预研究来测试改善哮喘控制的有效性。第三阶段产品将具有市场价值，因为它改进并记录了质量改进、认证信用维护、有意义的使用、临床质量测量、绩效薪酬和医疗之家工作的护理。