Clinical Decision Support Tool to Assess Risk and Prevent Agitation Events

用于评估风险和预防躁动事件的临床决策支持工具

• 批准号: 10365272
• 负责人: Ambrose H Wong
• 金额: $ 19.38万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365272
• 关键词: Accident and Emergency department; Address; Aggressive behavior; Agitation; Award; Behavioral; Biometry; Characteristics; Clinical; Clinical Decision Support Systems; Clinical Trials; Collection; Complex; Data; Dissemination and Implementation; Early Diagnosis; Early treatment; Education; Electronic Health Record; Emergency Department Physician; Emergency Medicine; Emergency department visit; Enrollment; Ensure; Environment; Environmental Risk Factor; Equilibrium; Event; Face; Foundations; Goals; Harm Reduction; Health Services Research; Health system; Institution; Intervention; Interview; Knowledge; Laboratories; Lead; Medical; Mental Health; Mental Health Services; Mental disorders; Mentors; Methods; Modeling; Modification; National Institute of Mental Health; Outcome; Patient risk; Patient-Focused Outcomes; Patients; Physical Restraint; Policies; Predictive Factor; Prevention; Process; Provider; Public Health Informatics; Qualitative Methods; Randomized; Recommendation; Recording of previous events; Research; Research Activity; Resources; Risk; Risk Assessment; Risk Factors; Safety; Self Efficacy; Sudden Death; Symptoms; System; Techniques; Technology; Testing; Time; Training; Traumatic injury; Validation; Variant; Violence; Visit; Work; acute care; base; care delivery; career; clinical center; clinical decision support; clinical decision-making; clinical development; clinical research site; clinical trial implementation; cohort; comorbidity; emergency settings; feasibility testing; health record; improved; patient safety; pilot trial; predictive modeling; preemptive intervention; prevent; rapid diagnosis; restraint; risk prediction model; risk stratification; sedative; severe mental illness; skills; support tools; tool; usability; user centered design

PROJECT SUMMARY/ABSTRACT This award is a four-year plan to support Ambrose Wong, MD, MSEd, an emergency physician, in his transition towards an independent research career that focuses on dissemination and implementation of services for mental health crises in general, non-psychiatric emergency settings. The long-term goal of his research is to improve safety related to symptoms of agitation. To date, Dr. Wong's training has focused on emergency medicine, qualitative methods, and education-based interventions. Under a team of co-mentors with expertise in biostatistics, psychiatric services research, health informatics, and clinical trial implementation, Dr. Wong will build on his preliminary work on agitation prevention and management to accomplish the following training goals: (1) acquire expertise in clinical prediction modeling, (2) gain foundational knowledge in preventing, treating, and investigating mental health crises, (3) study health informatics and development of clinical support tools, and (4) obtain fundamental skills in clinical trials. The application integrates formal coursework and training through mentored research activities. Behavioral conditions in acute care settings are rapidly rising in the U.S., with a 50% increase in number of general emergency department (ED) visits for mental health conditions over the past decade. Agitation, defined as excessive psychomotor activity leading to violent behavior, is often part of these patient encounters. Of the 1.7 million agitation episodes occurring annually in general EDs, 83% are associated with an underlying serious mental illness. Given the safety risks of agitation, clinicians commonly use physical restraint, which are associated with up to 37% risk of complications including traumatic injuries and even sudden death in patients. Thus, regulatory bodies and experts emphasize early risk assessment and use of behavioral techniques before agitation occurs. However, variability in practice and policy of these techniques exists in emergency settings. This is due to lack of knowledge regarding specific risk factors that predict the need for pre-emptive intervention and challenges in assessing these risk factors in the busy environment of an ED. The objective of this project is to develop and test the Early Detection and Treatment to Reduce Events with Agitation Tool (ED- TREAT), a clinical decision support system embedded in the electronic health record that will guide clinicians in early risk assessment and appropriate treatment of mental health patients likely to develop agitation. We will first derive a clinical model using health record data and preliminary analyses by our team that predicts which at-risk patients will develop agitation and require use of physical restraint. Next, we will develop and refine ED- TREAT through user-centered design techniques with clinicians and patients. Finally, we will conduct a pilot trial to test the feasibility, fidelity, and bedside acceptability of ED-TREAT. Aligned with NIMH's strategic priorities to use technology for improving mental health delivery in non-specialty settings, this study will form the basis for a subsequent full-scale clinical trial to examine ED-TREAT's effect on clinical outcomes.

项目概要/摘要 该奖项是一项为期四年的计划，旨在支持急诊科医生 Ambrose Wong（医学博士、教育硕士）在他的工作中 向专注于传播和实施的独立研究职业过渡 针对一般非精神科紧急情况下的精神健康危机的服务。他的长远目标 研究旨在提高与躁动症状相关的安全性。迄今为止，黄博士的培训重点是 急诊医学、定性方法和基于教育的干预措施。在共同导师团队的带领下 拥有生物统计学、精神病学服务研究、健康信息学和临床试验实施方面的专业知识， 黄博士将以他在躁动预防和管理方面的前期工作为基础，以实现 以下培训目标：(1) 获得临床预测建模方面的专业知识，(2) 获得以下方面的基础知识： 预防、治疗和调查心理健康危机，(3) 研究健康信息学和开发 临床支持工具，(4) 获得临床试验的基本技能。该应用程序集成了正式的 通过指导研究活动进行课程作业和培训。 在美国，急症护理环境中的行为状况正在迅速恶化，患病人数增加了 50% 过去十年中因心理健康问题而到急诊科 (ED) 就诊的次数。搅动， 被定义为导致暴力行为的过度精神运动活动，通常是这些患者遭遇的一部分。 在普通急诊室每年发生的 170 万次躁动发作中，83% 与潜在的 严重的精神疾病。考虑到躁动的安全风险，临床医生通常使用身体约束，这些方法包括： 与高达 37% 的并发症风险相关，包括患者外伤甚至猝死。 因此，监管机构和专家强调早期风险评估和行为技术的使用。 发生搅动。然而，在紧急情况下，这些技术的实践和政策存在差异。 这是由于缺乏对预测需要先发制人的特定风险因素的了解 在急诊室繁忙的环境中评估这些风险因素的干预和挑战。的目标 该项目旨在开发和测试早期检测和治疗以减少激动事件的工具（ED- TREAT），嵌入电子健康记录中的临床决策支持系统，可为临床医生提供指导 在早期风险评估和适当治疗中，心理健康患者可能会出现躁动。我们将 首先使用健康记录数据和我们团队的初步分析得出临床模型，预测哪些 高危患者会出现烦躁不安，需要采取身体约束措施。接下来，我们将开发和完善ED- 通过以用户为中心的设计技术与临床医生和患者一起进行治疗。最后，我们将进行试点 试验旨在测试 ED-TREAT 的可行性、保真度和床边可接受性。与 NIMH 的战略保持一致 优先使用技术来改善非专业环境中的心理健康服务，这项研究将形成 为后续全面临床试验检查 ED-TREAT 对临床结果的影响奠定了基础。