Demonstrating the potential for electronic health record interoperability to improve patient safety research of older adults over the acute episode of care.

展示电子健康记录互操作性的潜力，以改善老年人急性护理期间的患者安全研究。

• 批准号: 10728699
• 负责人: Anuj K Dalal
• 金额: $ 89.02万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728699
• 关键词: Acute; Address; Adoption; Adult; Adverse event; Agreement; All of Us Research Program; Caregivers; Caring; Clinical; Clinical Research; Collection; Computer software; Consent; Data; Data Aggregation; Data Analyses; Detection; Disparate; Elderly; Electronic Health Record; Enrollment; Ensure; Exposure to; Fast Healthcare Interoperability Resources; Funding; Health Personnel; Health system; Hospitalization; Hospitals; Individual; Information Systems; Infrastructure; Institution; Knowledge; Leadership; Measures; Mediation; Methods; Modeling; Natural Language Processing; Participant; Patient Recruitments; Patient Self-Report; Patients; Play; Population; Process; Provider; Public Policy; Research; Risk; Risk Factors; Role; Safety; Science; Secure; Services; Site; Source Code; Structure; Syndrome; Technology; Text; United States Agency for Healthcare Research and Quality; Woman; Work; acute care; adverse event risk; analytical method; care coordination; care episode; care fragmentation; clinical care; data exchange; data harmonization; data integration; data interoperability; data modeling; data sharing; data standards; design; digital; electronic data; electronic health data; empowerment; health care service; improved; information model; interoperability; multiple chronic conditions; novel; older patient; open source; participant enrollment; patient safety; prospective; research study; safety assessment; safety outcomes; safety study; secondary analysis; timeline; user centered design; web app

PROJECT SUMMARY Older adults with multiple chronic conditions (MCCs) are often hospitalized and are at risk for adverse events (AE) during acute episodes of care. Fragmented care across different healthcare providers is common for these patients and increases risk of AEs, especially in elderly patients with unrecognized geriatric conditions. Patient safety research that attempts to address these risks are limited by available data and often lack of access to electronic health records (EHR) from providers external to the health system conducting the research. We propose leveraging emerging interoperability standards, and public policies that require their adoption, to empower patients to locate, retrieve, and share their EHRs with our research team. We will partner with two studies that will enroll older adults and aim to reduce AEs during acute care episodes. Both studies have timelines suitable to consenting participants for this demonstration study. To accomplish our aims, we will leverage and enhance our existing digital infrastructure (a web-based application and secure backend cloud technology) that we have developed and implemented in past and ongoing work. Leadership of both partner studies will play major roles in this work, ensuring strong coordination. In Aim 1, we will enhance our existing digital infrastructure using two open-source projects. We will leverage infrastructure from the Sync-for-Science (S4S) Procure project (used in the All Of Us Research Program) enabling patients to use HL7 FHIR Services to find and share their EHRs with research teams. The MCC e-Care Plan project will supply clinical information models and value sets, ensuring that data collected can be used for both research and clinical care. User needs and requirements for identifying prior sites of care and sharing EHR data from those sites with the research team will be elicited via a rigorous user-centered design process. In Aim 2, we will implement and iteratively refine workflows defined in Aim 1 using mixed methods. In Aim 3 we will develop analytic methods for harmonizing aggregated EHR data and metrics relevant to our partner studies. These metrics will reflect care fragmentation based on EHR data aggregated using FHIR services, including unrecognized geriatric syndromes identified by applying natural language processing to unstructured text in retrieved clinical notes. In Aim 4, we will use these metrics as risk factors in a multivariable regression model to assess their effect on the safety outcomes of our partner studies. This analysis will demonstrate how novel assessments of care fragmentation and conditions common in geriatric populations contribute to AEs during acute care episodes. Our expert advisors, consultants, and software developers will assist with all clinical and technology aspects of this work. Our demonstration study will produce foundational knowledge regarding how to empower patients to collect and share their data with research teams, best practices for collecting data in this manner, and the value of using such data in studies of patient safety that are relevant to older adults. Finally, our contributions to two open-source projects will be made available for broad adoption to benefit other studies.

项目概要 患有多种慢性病 (MCC) 的老年人经常住院并面临不良事件的风险 (AE) 在急性护理期间。不同医疗保健提供者之间的分散护理是常见的 这些患者会增加 AE 的风险，尤其是患有未被识别的老年疾病的老年患者。 试图解决这些风险的患者安全研究受到可用数据的限制，并且往往缺乏 从卫生系统外部的提供者处获取电子健康记录 (EHR) 研究。我们建议利用新兴的互操作性标准以及需要这些标准的公共政策 采用，使患者能够定位、检索并与我们的研究团队共享他们的电子病历。我们将合作 两项研究将招募老年人，旨在减少急性护理期间的不良事件。两项研究 有适合同意参加本示范研究的参与者的时间表。为了实现我们的目标，我们将 利用和增强我们现有的数字基础设施（基于网络的应用程序和安全的后端云 技术）是我们在过去和正在进行的工作中开发和实施的。双方的领导力 研究将在这项工作中发挥重要作用，确保强有力的协调。在目标 1 中，我们将加强现有的 使用两个开源项目的数字基础设施。我们将利用 Sync-for-Science 的基础设施 (S4S) Procure 项目（用于 All Of Us 研究计划）使患者能够使用 HL7 FHIR 服务 查找并与研究团队共享他们的电子病历。 MCC e-Care Plan 项目将提供临床信息 模型和值集，确保收集的数据可用于研究和临床护理。用户 识别以前的护理地点并与这些地点共享 EHR 数据的需求和要求 研究团队将通过严格的以用户为中心的设计流程来组建。在目标 2 中，我们将实施并 使用混合方法迭代地完善目标 1 中定义的工作流程。在目标 3 中，我们将开发分析方法 用于协调与我们的合作伙伴研究相关的汇总 EHR 数据和指标。这些指标将反映 基于使用 FHIR 服务聚合的 EHR 数据的护理碎片，包括无法识别的老年人 通过将自然语言处理应用于检索到的临床记录中的非结构化文本来识别综合症。在 目标 4，我们将使用这些指标作为多变量回归模型中的风险因素来评估它们对 我们合作伙伴研究的安全结果。该分析将展示新颖的护理评估如何 老年人群中常见的碎片化和状况会导致急性护理期间的 AE。 我们的专家顾问、顾问和软件开发人员将在所有临床和技术方面提供协助 这项工作。我们的示范研究将产生有关如何赋予患者能力的基础知识 收集并与研究团队共享数据、以这种方式收集数据的最佳实践以及 在与老年人相关的患者安全研究中使用此类数据的价值。最后，我们的贡献 两个开源项目将可供广泛采用，以惠及其他研究。