Background: Measuring and improving healthcare quality is an important national challenge. The discussion about quality and disease management rarely happens during office visits when patients and providers have a unique opportunity to listen to each other and make collaborative decisions. Hypothesis: Encouraging patients to proactively measure and improve quality can bring remarkable efficiency, effectiveness and cost-savings to quality improvement efforts. Goal: To acquire skills to design and evaluate a patient-centric model, IBDPROMISE (IBD Patient Reported Outcomes and Medical IIlness Severity Evaluation), in which patients with inflammatory bowel disease (IBD) measure their quality of care metrics (such as colonoscopy surveillance) as well as quality of life in waiting rooms and at home; and physicians use this information at the point of care for quality improvement efforts.
The specific aims of the project are:
AIM I. Define a set of comprehensive quality of care metrics (such as immunization, appropriate colonoscopy surveillance) for IBD patients from national recommendations.
AIM II. Measure longitudinally quality of care metrics and quality of life (QOL).
AIM III. Conduct a randomized controlled trial to determine the impact of IBDPROMISE in improving outcomes (quality of care, quality of life, patient adherence, disease control and resource utilization). Methods: All eligible adult patients arriving in Mount Sinai Hospital IBD center and a community site during study recruitment will be offered tablet-based questionnaire in waiting rooms and enrolled once consented. After a baseline period (at least six months), participants in the IBDPROMISE arm will be asked to report their quality of care metrics and QOL every month for 18 months. This will generate an electronic health card (detailing disease summary, quality metrics and a graph showing the trend of QOL and healthcare utilization over time). Patients and providers will use the health card, active decision support (a drop in scores) and passive decision support (quality dashboards and reminders) to improve the quality of care collaboratively. Outcome: The primary end-point of the study is the proportion of patients in each group (IBDPROMISE vs. control) who meet all eligible quality metrics at week 104. Secondary endpoints will be comparison of quality of life, disease control rates and utilization of healthcare resources between the two arms. Additional analysis will be done to determine the impact of demographics, socioeconomic status and computer literacy on IBDPROMISE adoption and improvement in outcomes. Future Direction: This project will help me acquire critical skills in self-management, quality improvement, design of clinical trials and analysis of quality of life data and cost effectiveness. In the future, IBDPROMISE and its point of care QI model within EHR, if proven successful, will be made available license-free to other academic institutions, and help me implement multi-site clinical trials and prospective cohort studies in IBD.
Measuring and improving healthcare quality is an important national challenge. Improvement cannot be achieved if patients are not made aware of care quality that they are receiving, hence we are providing electronic Quality Report Cards to patients and providers that will bring discussion about quality and outcomes at the forefront of care and help improve patient outcomes.
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