Clinical Decision Support for Disseminating and Implementing Patient-Centered Outcomes Research (PCOR) Clinical Evidence

用于传播和实施以患者为中心的结果研究 (PCOR) 临床证据的临床决策支持

• 批准号: 10553545
• 负责人: Ronilda Lacson
• 金额: $ 88.01万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10553545
• 关键词: Clinical; Decision; Support; Disseminating; Implementing

Clinical decision support (CDS) systems can enhance the diagnostic process by minimizing diagnostic errors and delays, which are major components of patient safety. Recent federal regulations, including the Protecting Access to Medicare Act (PAMA), encourage CDS adoption and use by requiring that ambulatory providers consult with evidence-based Appropriate Use Criteria through qualified CDS mechanisms for ordering certain advanced imaging exams (e.g., CT, MRI). Optimally implemented, PAMA is a unique opportunity to improve the quality of diagnostic imaging care. However, if poorly executed, it could create interruptive electronic health record (EHR) workflows and low value clinical alerts, with little or no impact on diagnostic imaging utilization. The Harvard Medical School Library of Evidence (HMS-LOE) led a multi-disciplinary team of clinicians and medical informaticists to represent and grade clinical evidence in an effort to create CDS-consumable knowledge artifacts, which are publicly available at the HMS Countway Medical Library. Public domain sources of clinical evidence are represented as a Clinical Evidence Logic Statement (CELS) of “If-Then” form and graded using a system developed by the Oxford Centre for Evidence-Based Medicine for strength of evidence. 18% of the CELS in the HMS-LOE are also fully represented in standardized syntax and formats (e.g., Nomenclature of Medicine-Clinical Terms [SNOMED CT], Fast HealthCare Interoperability Resources [FHIR] and Clinical Quality Language [CQL]). CELS are specifically designed to be CDS-consumable and will greatly facilitate representation and public dissemination and sharing of artifacts. In this study, we will: 1) Assess the technical capability of FHIR, CQL and SNOMED CT to represent three patient-centered outcomes research (PCOR) guidelines from the HMS-LOE in a higher-level, structured representation, specifically a) Using Breast MRI (instead of or in addition to mammography) to diagnose a second breast cancer in women with previous breast cancer, b) Using CT scan for Pulmonary Embolism, and (c) Physician education for those at Risk for Pulmonary Embolism. In addition, we will: 2) Validate PCOR CELS represented in a structured representation at our healthcare system (Brigham and Women’s Hospital), and (3) Scale previously developed CDS artifacts to a different healthcare system (Covenant Health Inc.) with a different EHR implementation and health information technology (HIT) platform. Implementing transparently graded and represented knowledge artifacts will promote widespread dissemination and interoperability across varied HIT platform, end-users and workflows. In addition, validation and evaluation of the CDS artifacts, including usability and impact on clinical practice, will enhance widespread adoption. Ultimately, the goal of CDS for diagnostic imaging is to enhance evidence-based, effective care delivery.

临床决策支持（CD）系统可以通过最大程度地减少诊断错误来增强诊断过程 和延迟，这是患者安全的主要组成部分。最近的联邦法规，包括保护 访问Medicare Act（PAMA），通过要求门诊提供者来鼓励CD采用和使用 通过合格的CDS机制咨询基于证据的适当使用标准 高级成像考试（例如CT，MRI）。最佳实施，PAMA是改进的独特机会 诊断成像护理的质量。但是，如果执行不佳，它可能会产生中断的电子健康 记录（EHR）工作流程和低价值临床警报，对诊断成像的影响很小或没有影响。 哈佛医学院证据图书馆（HMS-LOE）领导了一个临床医生的多学科团队 代表和分级临床证据的医学信息，以创建可耗尽CD的临床证据 知识文物，可在HMS Countway医疗图书馆公开获得。公共领域来源 临床证据的临床证据逻辑陈述（CELS）表示为“如果然后”形式和 使用牛津循证医学中心开发的系统以进行证据强度进行分级。 HMS-LOE中18％的Cels也以标准化语法和格式完全表示（例如， 医学术语的命名法[Snomed CT]，快速医疗保健互操作性资源[FHIR] 和临床质量语言[CQL]）。 CELS专门设计为CDS耗费，将大大设计 促进代表和公众传播和分享工件。 在这项研究中，我们将：1）评估FHIR，CQL和SNOMED CT的技术能力以表示三个 以患者为中心的结果研究（PCOR）指南来自HMS-LOE的高层结构化 代表，特别是a）使用乳房MRI（代替或除乳房X线摄影之外）诊断 先前患有乳腺癌女性的第二种乳腺癌，b）使用CT扫描进行肺栓塞和 （c）对有肺栓塞风险的人的医师教育。此外，我们将：2）验证PCOR CELS 在我们的医疗保健系统（Brigham和妇女医院）和（3）中代表结构化代表 比例以前以其他医疗保健系统（Covenant Health Inc.）开发了CD伪像 不同的EHR实施和健康信息技术（HIT）平台。透明地实施 分级和代表的知识文物将促进宽度的传播和互操作性 多样化的热门平台，最终用户和工作流程。此外，CD伪像的验证和评估， 包括可用性和对临床实践的影响，将增强采用宽度。最终，目标的目标 用于诊断成像的CD是增强基于证据的有效护理输送。