Computerized Decision Support for Managing Lung Nodules

管理肺结节的计算机决策支持

• 批准号: 7086436
• 负责人: Michael K Gould
• 金额: $ 21.77万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-27 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7086436
• 关键词: adenomatous polyps; cancer prevention; cancer risk; clinical research; computer assisted medical decision making; computer assisted patient care; computer program /software; computer system design /evaluation; diagnosis quality /standard; health care policy; human data; hyperplasia; lung neoplasms; neoplasm /cancer diagnosis; patient care management; preneoplastic state; prognosis; statistics /biometry

DESCRIPTION (PROVIDED BY APPLICANT): Clinical practice guidelines are an essential tool for translating research findings into practice. Ideally, adherence to evidence-based guidelines should reduce unnecessary variation in the utilization of health care resources, contain costs and improve clinical outcomes. However, successful implementation of guidelines at the local level requires overcoming multiple barriers. One such barrier is a perception that the general recommendations found in guidelines do not apply to specific patients or practice settings. To address this and other known barriers to implementation, we propose to extend previous work in which we developed and tested a computer-based decision support system that generates evidence-based, patient-specific recommendations for the prevention of sudden cardiac death in at-risk populations. In the proposed research, we adapt our system and evaluate its impact on the management of patients with solitary pulmonary nodules. Management of lung nodules is a very attractive target for computer-based decision support. It is a common problem in both primary care and specialty settings, multiple possible management strategies exist, and the optimal management approach depends on pre-test probability, the risk of surgical complications, and several other factors. We aim to demonstrate that decision support can improve diagnosis and management in patients with solitary pulmonary nodules. To achieve this overall goal, we have three specific aims: (1) to develop ALCHEMIST-SPN, an interactive decision support system for management of patients with solitary pulmonary nodules, by linking a published decision analysis model and an existing architecture for computer-based decision support; (2) to validate the predictions generated by the ALCHEMIST-SPN decision support system; and (3) to conduct a controlled, cross-over trial of computer-based decision support for pulmonary nodule management by asking physician participants to manage a series of clinical vignettes that are based on actual patients with pulmonary nodules of known cause. By completing these aims, we will: (1) demonstrate the usefulness of an innovative strategy for creating and implementing evidence-based practice recommendations; (2) confirm that our system for decision support can be generalized to a management problem that is considerably more complicated than the one evaluated in our previous work; and (3) set the stage for a randomized trial of computer-based decision support with ALCHEMIST-SPN in real world clinical settings.

描述（由申请人提供）：临床实践指南是将研究结果转化为实践的重要工具。理想情况下，遵守基于证据的准则应减少医疗资源利用的不必要变化，包括成本并改善临床结果。但是，在地方一级成功实施准则需要克服多个障碍。这样的障碍是一种观念，即准则中发现的一般建议不适用于特定的患者或练习环境。为了解决这一和其他已知的实施障碍，我们建议扩展以前的工作，其中我们开发并测试了一种基于计算机的决策支持系统，该系统生成了基于证据的，特定于患者的建议，以预防高危人群中突然心脏死亡。在拟议的研究中，我们适应了我们的系统，并评估了其对孤立肺结节患者管理的影响。肺结节的管理是基于计算机的决策支持的非常有吸引力的目标。在初级保健和专业环境中，存在多种可能的管理策略，这是一个普遍的问题，最佳管理方法取决于测试前的概率，手术并发症的风险以及其他几个因素。我们旨在证明决策支持可以改善孤立肺结节患者的诊断和管理。 为了实现这一总体目标，我们有三个具体的目标：（1）通过将已发表的决策分析模型和基于计算机的决策支持的现有架构联系起来，开发了炼金术士SPN，这是一种用于管理具有孤立肺结节患者的互动决策支持系统； （2）验证炼金术士SPN决策支持系统产生的预测； （3）通过要求医师参与者管理一系列基于已知原因肺结核的实际患者的一系列临床小插曲，对肺结核管理的基于计算机的决策支持进行对照，跨界试验。 通过完成这些目标，我们将：（1）证明创新策略在创建和实施基于证据的实践建议方面的实用性； （2）确认我们的决策支持系统可以推广到一个管理问题，该问题比我们以前的工作中评估的问题要复杂得多； （3）为在现实世界临床环境中与Alchemist-SPN一起对基于计算机的决策支持的随机试验奠定了基础。