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在巴西三级医疗环境中促进对罕见病患者的综合护理:一项混合方法实施研究方案。

Promoting Comprehensive Care for People With Rare Diseases in a Tertiary Care Setting in Brazil: Protocol for a Mixed Methods Implementation Study.

作者信息

Alves Domingos, Andrade Bernardi Filipe, Costa Lima Vinicius, Bettiol Yamada Diego, Komoto Tatiana Takahasi, Seixas Michele de Souza, Cassão Victor, Fontanelli Straube de Souza Leticia, Dal Fabbro Amaury Lelis, Félix Têmis Maria, Cavalli Ricardo, Ferraz Victor Evangelista de Faria

机构信息

Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil, Ribeirão Preto, Brazil.

出版信息

JMIR Res Protoc. 2025 Aug 18;14:e68949.

Abstract

BACKGROUND

Rare diseases (RDs) have gained attention in public policy due to their complexity and low prevalence and the challenges they present in health care settings. Comprehensive care for people with RDs requires strengthening of services, programs, and care levels. It is imperative to make digital health tools available to support epidemiological surveillance, facilitate patient follow-up, and enhance the education and awareness of health care professionals (HCPs) regarding these conditions.

OBJECTIVE

This study aims to implement enhanced actions aligned with the Brazilian National Policy for Comprehensive Care for People with Rare Diseases to improve the attention and care provided to individuals. This will be achieved by developing a computational tool and establishing guidelines to optimize the regulation of the reference services for RDs, providing updated information to expedite diagnosis and promote collaboration.

METHODS

The methodology includes mapping the regulation processes in the Clinics Hospital of Ribeirão Preto Health Complex. Participants will include HCPs from the hospital complex and associated primary care centers and patients with a confirmed or suspected RD selected through medical records and patient associations. Data collection methods include questionnaires, semistructured interviews, and patient tracking using health information systems. The project will apply the 5W2H (what, who, where, when, why, how, and how much) framework to align tasks, responsibilities, and resources. Integrating digital tools adhering to the findability, accessibility, interoperability, and reusability principles will promote real-time monitoring, improved resource allocation, and enhanced workflow efficiency. Training initiatives will boost awareness and capacity among HCPs, while the computational tool seeks to streamline patient follow-up and tracking. Digital integration and interoperability will reduce referral process inefficiencies and support evidence-based decision-making. Education and awareness campaigns will fill knowledge gaps among HCPs and patients.

RESULTS

Ethics approval was granted on December 9, 2024. We conducted technical meetings with the IT team to align procedures for obtaining secondary data. Concurrently, we identified key guidelines and applied a knowledge management maturity questionnaire based on which we began mapping RD-related management processes. A computational ontology is currently under development to ensure semantic interoperability. This framework supported initiatives promoting education and awareness regarding RDs, targeting HCPs and patients.

CONCLUSIONS

The study emphasizes the potential of digital health solutions to transform RD care by improving coordination, resource allocation, and stakeholder education. When effectively adopted, these solutions can enhance access to specialized care, reduce inefficiencies, and inform public health policies. Future efforts will focus on expanding the tool's implementation, refining its functionalities, and evaluating its long-term impact on patient outcomes and system efficiency. This initiative highlights the crucial role of integrating digital technologies in managing RDs and underscores the need for ongoing collaboration among health care stakeholders to achieve sustainable improvements in patient care and policy development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/68949.

摘要

背景

罕见病因其复杂性、低患病率以及在医疗环境中带来的挑战而受到公共政策的关注。为罕见病患者提供全面护理需要加强服务、项目和护理水平。提供数字健康工具以支持流行病学监测、促进患者随访并提高医护人员对这些疾病的认识至关重要。

目的

本研究旨在实施与巴西罕见病患者全面护理国家政策相一致的强化行动,以改善对患者的关注和护理。这将通过开发一种计算工具并制定指南来实现,以优化罕见病参考服务的管理,提供最新信息以加快诊断并促进协作。

方法

该方法包括绘制里贝朗普雷图健康综合医院临床医院的管理流程。参与者将包括该医院综合设施及相关初级保健中心的医护人员,以及通过病历和患者协会挑选出的确诊或疑似患有罕见病的患者。数据收集方法包括问卷调查、半结构化访谈以及使用健康信息系统进行患者跟踪。该项目将应用5W2H(是什么、谁、在哪里、何时、为什么、如何以及多少)框架来协调任务、职责和资源。整合遵循可发现性、可访问性、互操作性和可重用性原则的数字工具将促进实时监测、改善资源分配并提高工作流程效率。培训举措将提高医护人员的认识和能力,而计算工具旨在简化患者随访和跟踪。数字整合和互操作性将减少转诊过程中的低效率并支持基于证据的决策。教育和宣传活动将填补医护人员和患者之间的知识空白。

结果

2024年12月9日获得伦理批准。我们与信息技术团队举行了技术会议,以协调获取二次数据的程序。同时,我们确定了关键指南并应用了知识管理成熟度问卷,在此基础上我们开始绘制与罕见病相关的管理流程。目前正在开发一种计算本体以确保语义互操作性。该框架支持针对医护人员和患者开展的有关罕见病的教育和宣传活动。

结论

该研究强调了数字健康解决方案通过改善协调、资源分配和利益相关者教育来改变罕见病护理的潜力。有效采用这些解决方案可以增加获得专科护理的机会、减少低效率并为公共卫生政策提供信息。未来的努力将集中在扩大该工具的实施范围、完善其功能以及评估其对患者结局和系统效率的长期影响。该举措凸显了整合数字技术在罕见病管理中的关键作用,并强调了医护利益相关者持续合作以在患者护理和政策制定方面实现可持续改善的必要性。

国际注册报告识别号(IRRID):PRR1-10.2196/68949

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a58a/12402734/d5e28d274e80/resprot_v14i1e68949_fig1.jpg

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