Conversational IT for Better, Safer Pediatric Primary Care

对话式 IT 提供更好、更安全的儿科初级护理

• 批准号: 7645710
• 负责人: WILLIAM G ADAMS
• 金额: $ 38.06万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-13 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7645710
• 关键词: Conversational; Better; Safer; Pediatric; Primary

A large gap exists between what is recommended for effective primary care of children and what actually takes place in pediatric primary care settings, especially in the areas of preventive care. Furthermore, although medication management (safety and effectiveness) issues have emerged as an important factor for children, little is known about how medication is actually used by families at home. Interactive telephony technologies offer a potentially highly effective, patient-centered communication modality by guiding parents at home through interactive discussions that can gather information and actively reinforce recommendations and treatments. Interactive telephony systems are particularly well suited for use in vulnerable populations since access to the telephone is nearly universal, and the system does not rely on reading printed text. We propose to develop and evaluate an integrated patient-centered health information system, the Personal Health Partner (PHP). The PHP will use fully automated, interactive, conversations to gather personal health data and counsel parents before scheduled visits, exchange that data with the child?s primary care clinician via the electronic health record (EHR), and offer personalized follow-up assessment and counseling after visits. The Personal Health Partner System will be evaluated in a randomized clinical trial to determine whether when compared to usual care: 1) PHP preventive and medication management assessments (without counseling) combined with EHR data exchange lead to higher quality preventive care and medication management; and 2) PHP with automated counseling is also associated with increased parental activation and healthier parental behaviors. We will also explore whether: 1) use of the PHP system will be feasible for parents and clinicians; 2) parents with low health literacy are able to use the PHP system as effectively as those with higher health literacy; 3) parents who receive PHP assessments with counseling are more likely to be counseled or change their behavior than those who receive PHP assessment only; and 4) the PHP system can automatically detect medications errors following new prescriptions in primary care settings. The IT-based approach to be evaluated in this project will link parents and children outside the clinical setting with their primary care center and will offer comprehensive assessments AND counseling to reinforce and support parental behavior change. With growing use of the EHR come new opportunities to link patient-centered information with clinical health information systems. Linkage of these systems has the potential to inform and activate parents, provide much richer data to drive decision support at the point-of-care, and to provide ongoing support for long-term behavior change following primary care visits. The use of conversational technologies as the foundation for the project offers a number of unique advantages especially the support of lower-literacy populations and near-universal access. Systems like the PHP represent a model for the future of ambulatory care and the sustainable, affordable delivery of higher quality and safer care by primary care clinicians in the future.

为儿童提供有效初级保健的建议与实际采取的措施之间存在很大差距 儿科初级保健机构，特别是预防保健领域。此外，虽然药物 管理（安全性和有效性）问题已成为儿童的一个重要因素，但人们对此知之甚少 家庭在家里实际如何使用药物。交互式电话技术提供了潜在的高度 通过互动讨论指导家长在家中建立有效的、以患者为中心的沟通方式 可以收集信息并积极强化建议和治疗。交互式电话系统是 特别适合弱势群体使用，因为电话几乎普及，而且 系统不依赖于阅读印刷文本。我们建议开发和评估一个以患者为中心的综合 健康信息系统，个人健康伙伴（PHP）。 PHP将使用全自动、交互式、 对话以收集个人健康数据并在计划访问之前向父母提供建议，与 儿童的初级保健临床医生通过电子健康记录 (EHR) 提供个性化的后续评估和 拜访后的咨询。 个人健康合作伙伴系统将在随机临床试验中进行评估，以确定何时 与常规护理相比：1) PHP 预防和药物管理评估（无咨询）相结合 通过 EHR 数据交换实现更高质量的预防保健和药物管理； 2) PHP 与 自动咨询还与增加父母的积极性和更健康的父母行为有关。 我们还将探讨：1）PHP 系统的使用对于家长和临床医生是否可行； 2）父母与 健康素养较低的人能够像健康素养较高的人一样有效地使用 PHP 系统； 3）父母谁 接受 PHP 咨询评估的人比接受 PHP 咨询的人更有可能得到咨询或改变自己的行为 仅接受 PHP 评估； 4) PHP系统可以自动检测新的药物错误 初级保健机构的处方。 本项目将评估基于信息技术的方法，将临床环境之外的父母和儿童与 他们的初级保健中心，并将提供全面的评估和咨询，以加强和支持父母 行为改变。随着 EHR 的使用不断增加，出现了将以患者为中心的信息与 临床健康信息系统。这些系统的联系有可能通知和激活父母，提供 更丰富的数据可推动护理点决策支持，并为长期行为提供持续支持 初级保健就诊后发生变化。使用对话技术作为该项目的基础提供了 一些独特的优势，特别是对识字率较低的人口的支持和近乎普遍的获取。 PHP 这样的系统代表了未来门诊护理和可持续、负担得起的医疗服务的模型 未来初级保健临床医生将提供更高质量、更安全的护理。