Quality Improvement and Practice Based Research in Neurology Using the EMR

使用 EMR 进行神经病学质量改进和基于实践的研究

• 批准号: 9101955
• 负责人: DEMETRIUS MICHAEL MARAGANORE
• 金额: $ 24.19万
• 依托单位: NORTHSHORE UNIVERSITY HEALTHSYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9101955
• 关键词: Quality; Improvement; Practice; Based; Research

 DESCRIPTION (provided by applicant): The goals of the proposed research are to advance quality improvement and practice based research in Neurology using the electronic medical record (EMR). The American Academy of Neurology (AAN) has published evidence-based guidelines, quality improvement measures, and resources for several neurological disorders. However, the AAN guidelines and measures have not been implemented routinely and benchmark data are lacking. There are few EMR tools available to standardize neurology office visits according to Best Practices, to provide alerts when neurological care is deviating from AAN guidelines, to capture data regarding adherence to AAN or other quality parameters, to measure the effects of compliance with guidelines on outcomes, or to share longitudinal data and to compare effectiveness of care across neurological practices. The Department of Neurology at NorthShore University HealthSystem (NorthShore) has built into its commercial EMR "Epic" structured clinical documentation support (SCDS) and clinical decision support (CDS) tools that standardize care, write progress notes, and capture up to 1,000 discreet and cascading fields of neurological data per office visit. However, these EMR tools have not been disseminated for use by other Neurology practices or for data sharing, and presently do not support clinical trials. Pragmatic trials using EMRs would enable comparisons of treatments at the point of care. To address gaps in quality improvement and practice based research in Neurology, we are proposing to the Agency for Healthcare Research and Quality (AHRQ) a project with the specific aims: 1) To create a Neurology Practice Based Research Network (NPBRN). The NorthShore site will share SCDS and CDS tools for 10 common neurological disorders (brain tumors, epilepsy, migraine, mild cognitive impairment, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson's disease, restless legs syndrome, and stroke) with seven other Department of Neurology that also use the Epic EMR platform (eight sites total). 2) To conduct at NorthShore pragmatic trials using the EMR for 10 common neurological disorders. We will demonstrate the feasibility of subgroup based adaptive assignment of treatments, electronic consenting, and outcomes data capture at the point of care using the EMR. We will identify the most effective treatments for common neurological disorders and seek replication by the NPBRN. Our aims are innovative because we will use the EMR to hardwire quality and outcomes research in Neurology. We will individualize medicine at the point of care by conducting pragmatic trials using subgroup based adaptive designs, comparing the effectiveness of available treatments for common neurological disorders. Our aims are significant because we are studying several neurological disorders, a leading cause of healthcare burden worldwide. We will create a national practice based network to improve health care quality by accelerating implementation of patient-centered outcomes research in Neurology using the EMR, and evidence to make health care safer and to improve health care efficiency.

 描述（由申请人提供）：拟议研究的目标是利用电子病历 (EMR) 推进神经病学的质量改进和基于实践的研究。美国神经病学学会 (AAN) 已发布基于证据的指南、质量改进。然而，AAN 指南和措施尚未得到常规实施，并且缺乏基准数据，可用于根据最佳实践标准化神经科就诊，以便在神经科护理时提供警报。偏离 AAN 指南，获取有关遵守 AAN 或其他质量参数的数据，衡量遵守指南对结果的影响，或共享纵向数据并比较不同神经病学实践的护理效果。 HealthSystem (NorthShore) 已内置于其商业 EMR“Epic”结构化临床文档支持 (SCDS) 和临床决策支持 (CDS) 工具中，这些工具可标准化护理、编写进度说明并捕获多达 1,000 个谨慎和然而，这些 EMR 工具尚未被其他神经病学实践使用或用于数据共享，并且目前不支持使用 EMR 进行的临床试验能够在治疗时进行比较。为了解决神经病学质量改进和基于实践的研究方面的差距，我们向医疗保健研究和质量机构 (AHRQ) 提议一个项目，其具体目标是： 1) 创建一个基于神经病学实践的研究网络。 (NPBRN) NorthShore 站点将共享针对 10 种常见神经系统疾病（脑肿瘤、癫痫、偏头痛、轻度认知障碍、轻度创伤性脑损伤、多发性硬化症、神经病、帕金森病、不宁腿综合征和中风）的 SCDS 和 CDS 工具。与其他七个神经科也使用 Epic EMR 平台（总共 8 个站点） 2) 在 NorthShore 使用 EMR 进行 10 种常见神经系统疾病的实用试验。将证明使用 EMR 在护理点进行基于亚组的自适应治疗分配、电子同意和结果数据捕获的可行性。我们将确定常见神经系统疾病的最有效治疗方法，并寻求 NPBRN 的复制。因为我们将使用 EMR 来进行神经病学的硬连线质量和结果研究，我们将通过使用基于亚组的适应性设计进行实用试验，比较常见神经系统疾病的现有治疗方法的有效性，从而实现个体化医疗。我们正在研究一些神经学我们将创建一个基于全国实践的网络，通过使用 EMR 加速实施以患者为中心的神经病学结果研究，并提供证据，使医疗保健更安全并改善医疗保健。效率。