Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and Liver Cancer (CLOVER)

加强电子卫生系统以减轻结肠癌、肺癌、肥胖、疫苗可预防疾病和肝癌的负担 (CLOVER)

基本信息

批准号：
10238837
负责人：
Eric W Chak
金额：
$ 29.38万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-15 至 2022-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY With the goal of improving medical care and reducing health disparities for the aging American population, the University of California, Davis (UCD) and University of California, Irvine (UCI) have collaborated to propose “Enhancing Electronic Health Systems to Decrease the Burden of Colon Cancer, Lung Cancer, Obesity, Vaccine-Preventable Illness, and LivER Cancer” (“CLOVER”). The overall goal of CLOVER is to develop, deliver, and disseminate electronic health systems (EHR)-based interventions that will improve the well-being of older adults through increasing the adherence to selected US Preventive Services Task Force (USPSTF) Grade A and Grade B recommendations and Centers for Disease Control and Prevention (CDC) vaccination recommendations. We will accomplish this goal through pilot (R61) and clinical trial (R33) phases using the following Specific Aims: Aim #1 (R61): Conduct Stage I Behavioral Intervention Development by algorithm development and testing of Epic Healthy Planet (HP) at UCD to identify patients at risk, but never screened for colon cancer or lung cancer. Aim #2 (R61 and R33): Utilizing the enhanced Epic HP, pilot-test evidence-based and customized interventions at both UCD and UCI to increase colon and lung cancer screening rate for at-risk individuals by 10%. Aim #3 (R61 and R33): Determine effectiveness of “bundled ordering” by assessing patients prior to their primary care visit for eligibility for colon and lung cancer screening, tobacco and obesity counseling, age-appropriate vaccination, and hepatitis C screening compared to single procedures in terms of time-saved. Aim #4 (R33): Conduct Stage IV Behavioral Intervention Development by expansion of CLOVER to the UCI federally qualified health center. Aim #5 (R61 and R33): Evaluate the impact of CLOVER on increasing adherence to selected USPSTF recommendations and reducing their disparities by demographic group. CLOVER will cleverly tailor Epic HP to institute 3 key interventions with multi-centered dissemination which will increase the aforementioned screenings, counseling, and vaccinations: 1) Electronic “bulk messaging” through the UCD patient-physician portal using messages that resonate by racial/ethnic groups, 2) “Bundled ordering” will be used by CLOVER staff to fulfill deficiencies in USPSTF and CDC recommendations simultaneously. This will include the use of the emerging technology video visits by which patients will connect to certified tobacco and obesity counselors using their smart phones without the need to travel to an appointment, and 3) “Tailored Health Maintenance” section in the patient's electronic medical chart will alert their PCP of remaining “care gaps” in USPSTF and CDC recommendations and facilitate shared decision making for patients who need additional counseling. If these Aims are achieved, adherence to USPSTF recommendations will be enhanced, and Epic, the EHR company who serves more than 250 million patients will consider incorporating CLOVER into its Foundation System for all organizations to consider adopting our approach.

项目概要为了改善美国老龄化人口的医疗保健并减少健康差距，加州大学戴维斯分校 (UCD) 和加州大学欧文分校 (UCI) 合作提出 “加强电子健康系统，减轻结肠癌、肺癌、肥胖症、疫苗可预防的疾病和 LiveR 癌症”（“CLOVER”） CLOVER 的总体目标是开发、提供和传播基于电子卫生系统 (EHR) 的干预措施，以改善人们的福祉通过提高对选定的美国预防服务工作组 (USPSTF) 等级的遵守程度，老年人 A 级和 B 级建议以及疾病控制和预防中心 (CDC) 疫苗接种我们将使用以下方法通过试点 (R61) 和临床试验 (R33) 阶段来实现这一目标。以下具体目标：目标 #1 (R61)：通过算法进行第一阶段行为干预开发都柏林大学开发和测试 Epic Healthy Planet (HP)，以识别处于危险中但从未进行过筛查的患者目标#2（R61 和 R33）：利用增强的 Epic HP、基于证据的试点测试。以及在UCD和UCI的定制干预措施，以提高高危人群结肠癌和肺癌筛查率目标 3（R61 和 R33）：通过评估患者确定“捆绑订购”的有效性。在初级保健就诊之前，以获得结肠癌和肺癌筛查、烟草和肥胖咨询的资格，适合年龄的疫苗接种和丙型肝炎筛查相比单一程序而言节省了时间。目标#4 (R33)：通过将 CLOVER 扩展到 UCI 进行第四阶段行为干预开发目标 #5（R61 和 R33）：评估 CLOVER 对增加的影响。遵守选定的 USPSTF 建议并减少不同人口群体之间的差异。 CLOVER将巧妙定制Epic HP，进行3大重点干预，多中心传播，增加上述筛查、咨询和疫苗接种：1) 通过电子“批量消息传递” 都柏林大学患者-医生门户网站使用引起种族/族裔群体共鸣的信息，2)“捆绑订购” CLOVER 工作人员将使用它来同时弥补 USPSTF 和 CDC 建议中的缺陷。将包括使用新兴技术视频访问，患者将通过该技术连接到经过认证的烟草和肥胖咨询师使用智能手机，无需前往预约，以及 3）“量身定制患者电子病历中的“健康维护”部分将提醒其 PCP 剩余的“护理差距” 纳入 USPSTF 和 CDC 的建议，并促进需要额外治疗的患者共同决策如果这些目标得以实现，将加强对 USPSTF 建议的遵守，并且 Epic、为超过 2.5 亿患者提供服务的 EHR 公司将考虑将 CLOVER 纳入其为所有组织考虑采用我们的方法提供基础系统。