Implementation of Point-of-Care Pharmacogenomic Decision Support in Perioperative Care - Resubmission 01

在围手术期护理中实施即时护理药物基因组决策支持 - 重新提交 01

基本信息

批准号：
10202687
负责人：
Peter Hugh O'Donnell
金额：
$ 80.95万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-27 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10202687
关键词：
Address Adopted Adoption Adverse effects Adverse event Analgesics Anesthetics Antihypertensive Agents Attitude Awareness Behavior Behavioral Blinded Cause of Death Climate Clinical Computer software Critical Care Decision Making Dissemination and Implementation Dose Drug Prescriptions Drug usage Education Elements Expectancy Exposure to Feasibility Studies Frequencies Genes Genetic Genetic study Genomics Goals Human Incidence Individual Informatics Institution Intervention Knowledge Learning Logic Measures Mediating Mediator of activation protein Medical Medicine Modeling Morbidity - disease rate Muscle relaxants Operative Surgical Procedures Outcome Outpatients Pain management Patient Care Patients Perception Perioperative Perioperative Care Pharmaceutical Preparations Pharmacogenomics Physicians Population Predisposition Process Provider Public Health Randomized Research Resources Risk Risk Reduction Behavior System Technology Test Result Testing Time Toxic effect Translating Translations Variant adverse drug reaction arm base burden of illness care providers clinical decision support clinical efficacy clinical examination clinical implementation clinical practice clinical translation genetic information genetic variant health care model high risk improved interest mortality novel operation peer personalized care point of care practice factors precision medicine prevent prospective provider behavior provider factors response screening sedative support tools tool

项目摘要

PROJECT SUMMARY/ABSTRACT Adverse drug reactions are a leading cause of death, and thousands of additional patients are prescribed medications which provide no benefit. Pharmacogenomics has allowed the discovery of genetic variants impacting response or toxicity for hundreds of drugs, but such information has infrequently been clinically utilized. Implementation has been hampered by poor physician knowledge, limited avenues for testing, delays in receipt of results, and informatics barriers to genomic implementation. There is also skepticism regarding the clinical utility of pharmacogenomics, underpinning the need for randomized examination of clinical efficacy. This was the genesis for our interest in proposing this project, which aims to understand whether a novel decision-support tool delivering patient-specific pharmacogenomic information can demonstrate that genetically-informed prescribing reduces inappropriate medication use in the perioperative and critical care settings. We previously developed and studied the tool, called the Genomic Prescribing System (GPS), among outpatient physician-patient pairs at our institution over the past five (5) years. GPS incorporates preemptively- obtained patient-specific pharmacogenomic results and translates these into clinical decision support summaries. The significance of this model is that it addresses several of the primary barriers to genomic implementation/dissemination–the need for instantaneous access to results at the point-of-care, translation of genomic information into decision-making logic, and provider education/decision support about genomics. We are interested to know whether our conceptual framework for adoption and use of pharmacogenomic information has unique mediators or unanticipated barriers in the perioperative setting, where anesthesiologists and critical care providers make many high-stakes prescribing decisions very rapidly. Additionally, in the perioperative setting the idea of pre-identifying patients who have genomic predisposition to increased medication risk has the potential for added clinical value that is greater than that for screening in other clinical populations, because for many perisurgical patients, it will be the first time having an operation (and thus the first time being exposed to various associated perioperative drugs). Our hypothesis is that a medical implementation model for personalized care that makes relevant pharmacogenomic information instantaneously accessible at the time of prescribing will reduce the use of inappropriate and high risk medications in patients for whom pharmacogenomic results are known. This hypothesis is based on the premise that the efficacious clinical translation of genomic discovery will be mediated by both systems/technology changes and changes in clinician behaviors. Impact on public health will result not only from the technology we employ but from our understanding of decision-making processes involved in promoting and adopting risk-reductive behavior in the era of precision medicine.

项目摘要/摘要不良药物反应是死亡的主要原因，开了数千名患者没有任何好处的药物。药物基因组学允许发现遗传变异影响数百种药物的反应或毒性，但是这种信息在临床上很少存在利用。实施受到了不良的身体知识，有限的测试途径，延误的途径受到阻碍在收到结果和基因组实施的信息障碍中。关于药物基因组学的临床实用性，基于对临床效率进行随机检查的需求。这是我们对提出这个项目的兴趣的创造性，该项目旨在了解小说是否是否提供特定患者的药物基因组信息的决策支持工具可以证明在周期性和重症监护中，遗传信息的处方减少了不适当的药物使用设置。我们之前开发并研究了该工具，称为基因组处方系统（GPS）在过去的五（5）年中，我们机构的门诊病患者对。全科医生预先合并 - 获得了患者特异性的药物基因组结果，并将其转化为临床决策支持概括。该模型的意义在于它解决了基因组的几个主要障碍实施/传播 - 需要瞬时访问结果的需求，基因组信息有关决策逻辑，以及有关基因组学的提供者的教育/决策支持。我们有兴趣知道我们采用和使用药物基因组的概念框架是信息在周期性的环境中具有独特的调解人或意外障碍重症监护提供者非常迅速地做出许多高风险的处方决策。另外，在定期设定具有基因组易感患者预先识别患者的想法药物风险具有增加临床价值的潜力，该价值大于其他临床的筛查人群，因为对于许多围牙患者，这将是第一次进行手术（因此第一次接触各种相关的周期性药物）。我们的假设是一种针对个性化护理的医学实施模型处方时可立即访问的药物基因组学信息将减少在药物基因组成果的患者中使用不适当和高风险药物是已知。该假设基于以下前提：基因组发现的有效临床翻译系统/技术变化和临床行为的变化都将介导。对公众的影响健康不仅是我们采用的技术，还会源于我们对决策的理解在精确医学时代，促进和采用降级风险行为涉及的过程。