Improving Minority Health By Computer Detection Of Follow-up Failures

通过计算机检测后续失败来改善少数人的健康

• 批准号: 7611077
• 负责人: PAUL M GERTMAN
• 金额: $ 10万
• 依托单位: U.S. CARELINK
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-25 至 2010-09-24
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7611077
• 关键词: Affect; Ambulatory Care Facilities; American; Appointment; Boston; Caring; Chest; Clinic; Clinical; Clinical Data; Collaborations; Colon Carcinoma; Communication; Communities; Community Health Centers; Community Health Networks; Complex; Computer Assisted; Computer software; Computers; Condition; Data; Databases; Detection; Development; Diabetes Mellitus; Diagnosis; Diagnostic tests; Disease; Drops; Early Diagnosis; Environment; Event; Failure; Future; Guidelines; Health; Health education; Health system; Hospitals; Human; Hypertension; Individual; Intervention; Interview; Language; Life; Long-Term Care; Malignant Neoplasms; Malignant neoplasm of lung; Medical Surveillance; Medical center; Minority; Modality; Monitor; Morbidity - disease rate; New England; Notification; Osteoporosis; Outcome; PSA screening; Patient Appointment; Patient Care; Patients; Pharmaceutical Preparations; Phase; Phase II Clinical Trials; Physicians; Population; Primary Health Care; Procedures; Process; Provider; Public Health; Pulmonary Mass; Quality of life; Radiology Specialty; Range; Rate; Reporting; Risk; Screening Result; Screening for Prostate Cancer; Screening procedure; Simulate; Site; Small Business Funding Mechanisms; Small Business Innovation Research Grant; Specific qualifier value; Staging; System; Technology; Test Result; Testing; Therapeutic Intervention; Time; Today; Visit; Work; base; care systems; design; follow-up; health care delivery; improved; inner city; malignant breast neoplasm; minority health; mortality; prescription document; prescription procedure; pressure; radiologist; research clinical testing; response; safety net; simulation; software systems; stressor; tool

DESCRIPTION (provided by applicant): The overall objective of this project is to design, test and implement an automated system which monitors health care delivery processes to identify potential breakdowns in follow-up care for patients with life threatening conditions. Patients with abnormal tests and clinical findings, showing potentially life-threatening conditions, do not get follow-up, those diagnosed may not get appropriate initial treatment, and others are not properly managed over the extended periods of time necessary to gain the potential additional years of quality living. These failures are accentuated in minority populations because of lack of physician continuity over time, under-resourced provider systems, language and cultural communication differences with providers, lack of health education among patients, and other stressors which contribute to sub-optimal care. The initial focus is on conditions involving abnormal findings on chest x-ray indicative of lung cancers, and abnormal prostate cancer screening and diagnostic tests; these cancers are more prevalent among minorities. On average, they are discovered at later stages of disease and do not receive as early or extensive interventions. While individual failures leading to worse outcomes can occur at multiple different points, some of the most egregious examples are: failure to review interpreted results of screening tests; failure to recommend/order appropriate follow-up abnormal test results or findings; and failure to detect sub-optimal therapy interventions. US CareLink (USCL) LLC, in collaboration with Boston Medical Center (the leading safety net hospital in New England) and its HealthNet community health centers, proposes to develop and demonstrate, for inner-city minority populations, a computer-based tool called TRACR (Tracking Results/Findings, Alerts and Clinical Responses). As a care monitoring tool, TRACR is designed to go beyond simple reminders and alerts to busy clinicians. It seeks to close the loop in key processes of care for a disease problem longitudinally across a patient's lifetime. The system actively identifies unresolved actions in the care process, notifies clinicians and/or patients of these, and continues to monitor the response of the clinicians and patients. During Phase 1, the underlying software technology will be developed, the clinical rules for monitoring and follow-up will be designed, and the system tested in a simulated environment. In Phase 2, an experimental field trial of TRACR problem detection and intervention from initial screening through initial full course of therapy will be conducted. The system will be implemented for half of the primary care clinics and community health centers with comparison of rates of patients having proper follow-up care compared to those with "usual care." If proven for these two problems, TRACR can be applied to many other clinical conditions where follow-up failures occur, causing avoidable morbidity and mortality, particularly in minority populations. Other candidates for future intervention include breast cancer, colon cancer, diabetes, osteoporosis and hypertension. PUBLIC HEALTH RELEVANCE: The software system proposed to being developed under this project aims to improve the followup of care in a variety of clinical conditions. The emphasis is on those clinical conditions and scenarios that disproportionately affect minority patients. The software will monitor asynchronously patient's clinical data and when events requiring followup are detected, but the followup action has not been performed, the software system will contact the physician or the patient or both as appropriate to insure that followup occurs..

描述（由申请人提供）：该项目的总体目的是设计，测试和实施一个自动化系统，该系统监视医疗保健提供过程，以确定针对患有危及生命状况的患者的后续护理中潜在细分。患有异常测试和临床发现的患者，表现出潜在的威胁生命的状况，没有得到随访，被诊断的患者可能无法获得适当的初始治疗，而其他患者则在较长的时间内无法正确管理，以获得潜在的额外额外质量生活年限。由于随着时间的流逝缺乏医师的连续性，资源不足的提供者系统，语言和文化沟通差异与提供者，患者缺乏健康教育以及其他有助于次级护理的压力源，这些失败在少数群体中得到了强调。最初的重点是涉及胸部X射线异常发现的条件，指示肺癌，前列腺癌筛查异常和诊断测试。这些癌症在少数民族中更为普遍。平均而言，它们是在疾病后期发现的，并且没有接受早期或广泛的干预措施。虽然可以在多个不同的角度发生个体失败导致较差的结果，但一些最令人震惊的例子是：未能审查筛查测试的解释结果；未能推荐/订购适当的随访异常测试结果或发现；以及未能检测到亚最佳治疗的干预措施。美国Carelink（USCL）LLC与波士顿医疗中心（新英格兰领先的安全网医院）及其HealthNet社区健康中心合作，建议开发和证明，为基于计算机的工具（一种称为TRACR）（跟踪结果/发现/发现，警报，警报和临床响应）为基于计算机的少数群体人口）。作为一种护理监控工具，TRACR旨在超越简单的提醒和对繁忙的临床医生的警报。它试图在患者一生中纵向关闭疾病问题的关键护理过程中的循环。该系统在护理过程中积极识别未解决的动作，通知临床医生和/或患者，并继续监测临床医生和患者的反应。在第1阶段，将开发基础软件技术，将设计监视和随访的临床规则，并在模拟环境中进行测试。在第2阶段，将对从初始筛查到初始完整治疗过程进行TRACR问题检测和干预的实验现场试验。该系统将针对一半的初级保健诊所和社区保健中心实施，并比较具有适当随访的患者与“通常护理”的患者。如果证明这两个问题，则可以将TRACR应用于发生随访失败的许多其他临床状况，从而避免了发病率和死亡率，尤其是在少数人群中。未来干预的其他候选者包括乳腺癌，结肠癌，糖尿病，骨质疏松和高血压。 公共卫生相关性：建议在该项目下开发的软件系统旨在改善各种临床条件下的护理后续行动。重点是对少数族裔患者的临床状况和情况不成比例。该软件将监视异步的患者的临床数据，并且在检测到需要随访的事件时，但是尚未执行后续操作，软件系统将与医生或患者或两者兼有联系以确保随访的情况。