domingo, 28 de marzo de 2010
Enabling Patient-Centered Care through Health Information Technology (Health IT)
Patient-Centered Care & Health IT
Full Title: Enabling Patient-Centered Care through Health Information Technology (Health IT)
Evidence-based Practice Center Review Protocol
Expected Release Date: late 2010
Background and Objectives for the Systematic Review
Proposed Literature Search and Review
Definition of Terms
Summary of Protocol Amendments
Background and Objectives for the Systematic Review
The Agency for Healthcare Research and Quality (AHRQ) requested an evidence report on the "Enabling Patient-centered Care through Health IT." This report focuses on the development of a comprehensive understanding of the impact of health information technology (IT) applications developed and implemented to enhance the provision of patient-centered care. AHRQ is requesting a report that reviews the literature on the evidence of the impact of currently developed health IT applications on patient-centered care, identifies the gaps in the literature and recommends future research endeavors in order to better assess these IT applications' impact on patient-centered care.
Patient-centered care is defined by the Institute of Medicine (IOM) as "care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions."1 It was recognized by the IOM as one of the six major domains of quality. While the potential of health IT in enabling patient-centered care has been widely recognized, evidence-based comprehensive analysis of its impact on quality of care has not been conducted. In addition, barriers and facilitators of health IT-enabled patient-centered care (PCC) have not been reviewed systematically. We will review the evidence regarding the proposed questions, focusing on the effectiveness of health IT applications enabling patient-centered care in improving care processes, clinical outcomes, and intermediate outcomes such as patient/provider satisfaction, health knowledge and behaviors, cost and physiologic measures. Our report will address the value of health IT-enabled PCC, and research gaps with particular attention to its role in improving shared decision making, patient-clinician communication and access to medical information. The perspective of clinicians, developers, consumers and their families will be addressed in our review of the barriers and facilitators of health IT-enabled PCC implementation.
1. What evidence exists that health IT applications which enable clinicians to provide patient-centered care or patients to elicit patient-centered care are effective in improving:
a. Clinical outcomes for patients (including quality of life)?
b. Health care process outcomes (e.g. receiving appropriate treatment)?
c. Intermediate outcomes such as patients' improved health knowledge, health behaviors and physiologic measures, patient satisfaction, and reduced costs?
d. Responsiveness to the needs and preferences of individual patients?
e. Improving shared decision-making between patients, their families, and providers, clinician communication, or providing patients and clinicians access to medical information?
º How does the impact on improving clinical, health care process, intermediate, or responsiveness outcomes vary by type of health IT application?
2. What are barriers, drivers or facilitators that clinicians, developers, and their families or caregivers encounter that may impact implementation and use of health IT applications to enable patient-centered care?
º How do these barriers, drivers or facilitators vary by type of health IT application?
3. What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, impact, sustainability, and net value with regard to enabling patient-centered care through health IT? Discuss gaps in research, including specific areas that should be addressed and suggest possible public and private organizational types to perform the research and/or analysis.
4. What critical information regarding the impact of health IT applications implemented to enable patient-centered care is needed in order to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?
The target population will include health care providers utilizing health IT to deliver patient-centered care. We will impose no sex, age, or geographic limitations.
Health IT that enables patient-centered care includes computer-based and telecommunication information systems designed to assist clinicians in providing medical care that is respectful of and responsive to individual patient preferences, needs and values.
The intervention must be designed to interact directly with clinicians, who are assisted by the patient-centered health information system in delivering care which is tailored to patient needs and preferences.
For the initial consideration, we will include any health information system assisting clinicians in addressing at least one component of patient-centered care from the set of components defined by a conceptual model of patient-centered care. We may decide to focus primarily on health IT that addresses multiple components of PCC.
We will include randomized controlled trials on health IT implemented to enable patient-centered care (Key Question 1). If no RCTs are identified by our searches, we will consider well-designed interrupted time series analyses (ITS) or quasi-experimental study designs. In these studies, the comparators may be usual care or any other intervention.
We will accept observational studies such as surveys, where the main purpose of the study is closely aligned with Key Question 2 being addressed in our review.
^ Outcomes for each question:
Below is a general list of outcomes that the EPC team will be looking at for Key Questions 1 and 2. A more complete list of outcomes of interest will be submitted after the conceptual framework is completed and comments are received from the Technical Expert Panel (TEP):
-Clinical outcomes (e.g., mortality, morbidity, and quality of life).
-Health care process outcomes (e.g., receiving appropriate treatment).
-Intermediate outcomes (e.g., patients improved health knowledge, changes in health behavior, patient satisfaction with care, cost reduction).
-Responsiveness to patient needs and preferences of individual patients (e.g., patient-clinician communication, respect for patient values, publicly available information, whole person orientation).
-Improved shared decisionmaking (e.g., routine patient feedback, patient engagement in care, information sharing).
At the point of care and at any follow-up period.
Studies may be conducted in any clinical setting (e.g., hospital or outpatient facility) for the intervention, in any country.
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