Improving the Diagnosis of Liver Disease in Primary Care Patients with Abnormal Liver Function

改善肝功能异常的初级保健患者的肝病诊断

基本信息

批准号：
10359758
负责人：
Andrew David Schreiner
金额：
$ 17.25万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
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：
2018-07-17 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10359758
关键词：
Acute Liver Failure Address Age Alcohol consumption Alcoholic Liver Diseases Alcohols Americas Antiviral Therapy Biometry Cardiovascular Diseases Caring Cause of Death Chronic Cirrhosis Clinic Clinical Clinical Management Communities Data Death Rate Diagnosis Diagnostic Diagnostic Errors Disease Early Diagnosis Economic Policy Electronic Health Record Europe Funding Goals Health Policy Health Services Research Healthcare Heart Diseases Hepatitis C Therapy Hepatology Herbal supplement Hyperglycemia Hypertension Individual Infection Information Technology Institute of Medicine (U.S.)Intervention Laboratories Laboratory Study Lead Link Liver Liver Failure Liver Function Tests Liver diseases Malignant Neoplasms Malignant neoplasm of liver Medicine Mentorship Modeling Obesity Outcome Patient Care Patient-Focused Outcomes Patients Pattern Persons Pharmacology Play Portal Hypertension Positioning Attribute Predictive Analytics Primary Care Physician Primary Health Care Process Recording of previous events Research Resources Risk Risk Estimate Role Testing Time Training United States Viral hepatitis Work accurate diagnosis base career clinical risk clinically significant drug induced liver injury effectiveness evaluation end stage liver disease experience health care delivery health economics improved intravenous drug use liver function mortality non-alcoholic fatty liver disease novel strategies predictive modeling primary care setting psychosocial support tools

项目摘要

Abstract Improving the Diagnosis of Liver Disease in Primary Care Patients with Abnormal Liver Function Tests Through Predictive Modeling Reducing diagnostic error has been identified by the Institute of Medicine as a top national priority. Diagnostic errors pervade all of healthcare, with the average individual experiencing one major error during their lifetime. Therefore, improving the diagnostic process and reducing diagnostic error is not only highly appropriate for all patients, but will play a crucial role in optimizing the quality and value of healthcare delivery in the United States.1 Liver disease, with complications including acute liver failure, cirrhosis, and liver cancer ranks as a leading cause of death in America and over recent years has had a significant climb in age-adjusted mortality, while death rates from heart disease and cancer have fallen.2 Despite the increasing preventability of liver-related conditions through early recognition and treatment, the toll of chronic and end stage liver disease continues to rise.3 The traditional diagnostic process, a synthesis of information gathered from history, physical exam, and laboratory testing, performs poorly in the detection of early liver disease.4,5 Instead, clinicians rely more heavily on laboratory studies, and liver function tests (LFTs) in particular.6 Abnormal LFTs are among the most frequently encountered findings in medicine.7,8 Currently, primary care clinicians currently lack the ability to consistently identify liver-related disease from these abnormalities.9-12 Preliminary data in primary care emphasize the immense scope of the problem; in studies from Europe, LFTs have been found elsewhere to be abnormal in nearly 1 in 5 people.13,14 In our preliminary studies, we have up to 40% of patients seen in an academic primary care clinic possessed at least one abnormal LFT. Further, these abnormal liver tests are inappropriately or inadequately followed-up. These data and our own experience indicate that primary care physicians (PCPs) lack the resources to reliably identify and accurately diagnose liver-related diseases amongst these many abnormal LFTs. In this proposal, the candidate and his mentorship team seek to harness inter-professional teamwork and information technology to reduce diagnostic error. They will identify clinical and demographic variables of patients with abnormal LFTs associated with specific liver-related diagnoses in primary care (Aim 1). Additionally, they will develop and validate a predictive model to identify patients with abnormal LFTs at risk for liver-related diagnoses (Aim 2). Lastly, they will create a decision support tool application to aid PCPs confronted with abnormal LFTs to promptly and accurately diagnose liver disease (Aim 3).

抽象的改善肝功能检查异常的初级保健患者的肝病诊断通过预测建模减少诊断错误已被医学研究所确定为国家的首要任务。诊断错误遍及所有医疗保健领域，平均每个人在一生中都会经历一次重大错误。因此，改进诊断流程、减少诊断错误不仅非常适合所有人患者，但将在优化美国医疗保健服务的质量和价值方面发挥至关重要的作用状态.1 肝脏疾病及其并发症，包括急性肝功能衰竭、肝硬化和肝癌，被列为主要疾病近年来，美国的死因年龄调整死亡率显着上升，而心脏病和癌症的死亡率有所下降。2 尽管肝脏相关疾病的可预防性不断提高通过早期识别和治疗，慢性和终末期肝病的死亡人数继续上升崛起.3 传统的诊断过程是综合从病史、体格检查和诊断中收集的信息。实验室检测在早期肝病检测方面表现不佳。4,5 相反，临床医生更加依赖实验室研究，尤其是肝功能测试 (LFT)。6 LFT 异常是最常见的医学上经常遇到的发现。7,8 目前，初级保健临床医生缺乏能力从这些异常中持续识别肝脏相关疾病。9-12 初级保健的初步数据强调了该问题的广泛性；在欧洲的研究中，LFT 在其他地方发现近五分之一的人存在异常。13,14 在我们的初步研究中，我们发现在学术初级保健诊所就诊的患者中，40% 的患者至少有一项 LFT 异常。更远，这些异常的肝脏检查没有得到适当或不充分的随访。这些数据和我们自己的经验表明，初级保健医生 (PCP) 缺乏资源来可靠地识别和准确地识别在众多异常 LFT 中诊断肝脏相关疾病。在此提案中，候选人及其导师团队寻求利用跨专业团队合作和信息技术减少诊断错误。他们将确定临床和人口统计学变量初级保健中 LFT 异常与特定肝脏相关诊断相关的患者（目标 1）。此外，他们将开发并验证一个预测模型，以识别 LFT 异常且有以下风险的患者：肝脏相关诊断（目标 2）。最后，他们将创建一个决策支持工具应用程序来帮助 PCP 面对 LFT 异常，及时准确诊断肝病（目标 3）。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The Cost of Hepatitis C Testing Strategies in Primary Care Patients with Abnormal Transaminases.

转氨酶异常的初级保健患者丙型肝炎检测策略的成本。

DOI：
发表时间：
2020
期刊：
影响因子：
5.7
作者：
Schreiner, Andrew D;Rockey, Don C;Moran, William P
通讯作者：
Moran, William P

When Do Clinicians Follow-up Abnormal Liver Tests in Primary Care?

临床医生何时对初级保健中的异常肝脏检查进行随访？

DOI：
发表时间：
2019
期刊：
影响因子：
0
作者：
Schreiner, Andrew D;Bian, John;Zhang, Jingwen;Kirkland, Elizabeth B;Heincelman, Marc E;Schumann 3rd, Samuel O;Mauldin, Patrick D;Moran, William P;Rockey, Don C
通讯作者：
Rockey, Don C

Abnormal Liver Enzymes.

肝酶异常。

DOI：
发表时间：
2019-09
期刊：
影响因子：
5.7
作者：
Bian, John;Schreiner, Andrew D;Rockey, Don C
通讯作者：
Rockey, Don C

Associations of Race with Follow-up Patterns After Initial Abnormal Liver Tests in Primary Care.

初级保健中初始肝脏检查异常后种族与后续模式的关联。

DOI：
发表时间：
2018
期刊：
影响因子：
5.7
作者：
Bian, John;Schreiner, Andrew D;Zhang, Jingwen;Schumann, Samuel O;Rockey, Don C;Mauldin, Patrick D;Moran, William P
通讯作者：
Moran, William P

Chronic liver disease is not associated with statin prescription in a primary care cohort.

在初级保健队列中，慢性肝病与他汀类药物处方无关。