Leveraging Electronic Health Records to Measure and Reduce Harmful, Low-Value Care Among Older Adults

利用电子健康记录来衡量和减少老年人中有害的低价值护理

基本信息

批准号：
10261576
负责人：
John Mafi
金额：
$ 24.3万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
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：
2020-09-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10261576
关键词：
Address Adoption Advanced Development Aging American Appointment Award Caring Clinic Clinical Clinical Data Consensus Country Data Delirium Development Elderly Electronic Health Record Funding Future Gastroenterologist General Practices Geriatrics Goals Health Health Services Research Health system Healthcare Human Insurance Carriers Internal Medicine Intervention Intervention Trial Interview K-Series Research Career Programs Knowledge Lead Leadership Measurement Measures Medical Medical Informatics Medicare Mentors Methods Modeling Paper Patient Care Patients Pharmaceutical Preparations Pharmacists Phase Physicians Polypharmacy Population Primary Health Care Principal Investigator Proton Pump Inhibitors Publishing Quality of Care Randomized Research Scientist Secure Sensitivity and Specificity Series Subgroup Testing Time Training Uncertainty United States United States Agency for Healthcare Research and Quality Universities Validity and Reliability Work aged base behavior change behavioral economics career career development clinical decision support design digital electronic structure evidence base improved inclusion criteria innovation point of care pragmatic trial professor prototype skills support tools therapy design tool virtual

项目摘要

ABSTRACT I (John N. Mafi, MD, MPH) am an Assistant Professor at UCLA, with a secondary Natural Scientist appointment at RAND. I practice general internal medicine and pursue health services research focused on identifying and reducing low-value care—patient care that provides no net benefit in specific clinical scenarios, and can also cause harm. After receiving outstanding training in health services research at Harvard University and publishing a series of papers on low-value care, I have turned the focus of my research on studying older adults because they disproportionately suffer from low-value care and its consequences. A major barrier to reducing low-value care in older adults is a lack of valid measures: current measurement relies on claims data (e.g., billing claims physicians submit to Medicare) that lack enough clinical detail to correctly classify care as “low value.” In contrast, electronic health records (EHRs) contain richer clinical data and are also a potential tool for reducing low-value care. To advance my career goals and improve care for older adults, I propose to develop an EHR-based low-value care measure (“eMeasure”), and then design and test an intervention consisting of a behavioral economic EHR clinical decision support tool (EHR CDS) to reduce low-value care in older adults. My prototype focus will address low-value proton pump inhibitor (PPI) drugs, which are associated with some harm. My overarching goal is to improve the health and healthcare of older Americans by becoming a leading principal investigator utilizing the EHR to measure and reduce low-value care in older adults. To achieve this goal, I seek support from the NIA Beeson Career Development Award. I have the support of an outstanding group including primary mentor Dr. Catherine Sarkisian (Professor, PI of NIA-R01 pragmatic trial), co-primary mentor Dr. Cheryl Damberg (PI of RAND/AHRQ U19 Center), mentors Dr. Ron Hays (Quality Measure Expert), Dr. Eric Cheng (Chief Medical Informatics Officer), Dr. Noah Goldstein (Economist), and collaborators Dr. Folasade May (Gastroenterologist), Dr. Sam Skootsky (Chief Medical Officer), and Dr. Chi- Hong Tseng (Statistician). I will acquire skills in EHR-based quality measure development and utilization (Damberg/Hays/Cheng), geriatrics (Sarkisian), behavioral economics and behavior change (Goldstein), pragmatic trials testing user-centered EHR decision support (Sarkisian/Damberg/Cheng), and leadership. I propose 3 specific aims for my career development: (1) Develop and test an eMeasure of low-value PPI prescriptions among older adults, (2) Design and pilot test an intervention (behavioral economic EHR CDS) to reduce low-value PPI prescriptions in older adults to determine feasibility and (3) Implement and evaluate a delayed-onset pragmatic trial of the intervention at UCLA Health—informing an NIA R01 proposal for a multisite pragmatic trial. I will apply knowledge learned from my training to Aims #1-3. The Beeson Award would provide me with the training and skills needed to become a national leader and independent clinician scientist utilizing the EHR to rigorously measure and reduce harmful, low-value care among older Americans.

抽象的我（John N. Mafi，医学博士、公共卫生硕士）是加州大学洛杉矶分校的助理教授，还有一名二级自然科学家我在兰德公司任职，从事普通内科医学工作并从事健康服务研究。识别和减少低价值护理——在特定临床情况下不提供净效益的患者护理，在哈佛大学接受过出色的卫生服务研究培训后，也可能造成伤害。并发表了一系列有关低价值护理的论文，我将研究重点转向研究老年人成年人，因为他们不成比例地遭受低价值护理及其后果的主要障碍。减少老年人的低价值护理缺乏有效的措施：当前的衡量依赖于索赔数据（例如，医生向 Medicare 提交的账单索赔）缺乏足够的临床细节来正确地将护理分类为 “价值低。”相比之下，电子健康记录（EHR）包含更丰富的临床数据，也是一种潜在的选择。为了推进我的职业目标并改善对老年人的护理，我建议：制定基于 EHR 的低价值护理措施（“eMeasure”），然后设计和测试干预措施包括行为经济 EHR 临床决策支持工具 (EHR CDS)，以减少低价值护理我的原型重点将解决相关的低价值质子泵抑制剂 (PPI) 药物。我的首要目标是通过成为改善美国老年人的健康和医疗保健。一位主要的首席研究员利用 EHR 来衡量和减少老年人的低价值护理。为了实现这一目标，我寻求 NIA Beeson 职业发展奖的支持。包括首席导师 Catherine Sarkisian 博士（NIA-R01 实用主义 PI 教授）在内的杰出团队试验），联合主要导师 Cheryl Damberg 博士（兰德/AHRQ U19 中心 PI），导师 Ron Hays 博士（质量测量专家）、Eric Cheng 博士（首席医学信息官）、Noah Goldstein 博士（经济学家）和合作者 Folasade May 博士（胃肠病学家）、Sam Skootsky 博士（首席医疗官）和 Chi 博士 Hong Tseng（统计学家）。我将获得基于 EHR 的质量测量开发和利用的技能。（Damberg/Hays/Cheng）、老年病学（Sarkisian）、行为经济学和行为改变（Goldstein）、务实试验测试以用户为中心的 EHR 决策支持（Sarkisian/Damberg/Cheng）和领导力。我为我的职业发展提出了3个具体目标：（1）开发并测试低值PPI的eMeasure 老年人的处方，(2) 设计并试点测试干预措施（行为经济 EHR CDS）减少老年人的低价值 PPI 处方以确定可行性，并且 (3) 实施和评估加州大学洛杉矶分校健康中心的延迟性实用干预试验——为 NIA R01 提案提供信息我将把从培训中学到的知识应用到 Beeson 奖的目标中。将为我提供成为国家领导人和独立临床医生所需的培训和技能科学家利用电子病历严格衡量和减少美国老年人中有害的、低价值的护理。