Evaluation of Computerized Decision Support for Managing Lung Nodules

肺结节管理计算机决策支持的评估

• 批准号: 8073972
• 负责人: Michael K Gould
• 金额: $ 9.98万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 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 2011-08-12
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073972
• 关键词: Adherence; Algorithms; Benign; Biopsy; Caliber; Cancerous; Chest; Clinical; Clinical Management; Clinical Medicine; Computer Architectures; Computers; Decision Making; Decision Modeling; Decision Support Systems; Diagnosis; Diagnostic; Effectiveness; Evaluation; Excision; Exposure to; Feedback; Frequencies; Funding; Future; Goals; Grant; Health; Healthcare; Intervention; Knowledge; Laboratories; Lead; Link; Lung; Lung nodule; Malignant - descriptor; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Methods; Modeling; Nodule; Online Systems; Operative Surgical Procedures; Outcome; Patient Care; Patient Preferences; Patient observation; Patients; Peer Review; Performance; Physicians; Population; Primary Health Care; Probability; Process; Pulmonary Coin Lesion; Qualitative Methods; Randomized Controlled Trials; Recommendation; Research; Risk; Site; Smoker; Solitary Nodule; Spottings; Surgical complication; System; Testing; Thoracic Oncology; Thoracic Surgeon; Time; Unnecessary Surgery; Validation; base; clinical practice; computerized; cooperative study; cost; cost effectiveness; design; improved; innovation; medical specialties; member; novel; programs; randomized trial; tool; trial comparing; usability

DESCRIPTION (provided by applicant): In previous research, members of our group developed ALCHEMIST, a computerized decision support system that generates patient- and site-specific recommendations for patient management based on decision- analytic models. Subsequently, we developed ALCHEMIST-SPN, a web-based decision support system for managing patients with solitary pulmonary nodules (SPN), by linking a rigorously developed decision analytic model with the existing ALCHEMIST architecture for computer-based decision support. Concurrently, we performed a statistical validation of the decision model, and showed that decision support with ALCHEMIST-SPN has the potential to improve quality-adjusted survival, reduce cost, and reduce the frequency of unnecessary surgery in patients with benign nodules and inappropriate "watchful waiting" in patients with malignant nodules. Management of lung nodules is a very attractive target for computer-based decision support; it is a common problem, multiple possible management strategies exist, and the optimal management approach depends on pre-test probability, the risk of surgical complications, patient preferences, and other factors. In this second revision of our competing renewal application, we seek funding to continue our systematic evaluation of ALCHEMIST-SPN. Specifically, we have revised our aims and methods based on helpful feedback from reviewers of our previous applications. The revised proposal includes three specific aims: (1) to conduct a rigorous process of usability testing and peer review, to enable design and refinement of a decision support system that is highly responsive to the needs of potential users; (2) to determine whether ALCHEMIST-SPN has the potential to improve outcomes in patients with lung nodules under idealized laboratory conditions, by conducting a randomized, controlled trial that compares management of clinical vignettes by physicians following exposure to either ALCHEMIST-SPN or a static flow-chart algorithm; (3) to implement ALCHEMIST-SPN in two health care settings, by integrating the decision support system into the clinical workflow of SPN management, and to conduct a "before and after" implementation study of ALCHEMIST-SPN in these settings to determine whether clinicians will use the decision support system and adhere to its recommendations. By accomplishing these aims, we will not only evaluate the performance of a highly innovative computerized decision support system for managing lung nodules, but also improve the system's performance based on feedback from both experts and practicing clinicians in laboratory and clinical settings. Ultimately, we believe that our approach to computerized decision support with ALCHEMIST-SPN has the potential to improve management in patients with lung nodules, and may be broadly applicable to other challenging problems in thoracic oncology and clinical medicine. PUBLIC HEALTH RELEVANCE This research aims to evaluate a novel, computer-based system for improving management in patients with solitary pulmonary nodules (or "spots on the lung"), which sometimes represent a curable form of lung cancer. By evaluating and eventually implementing the system, we aim to reduce the frequency of unnecessary surgery in patients with non-cancerous lung nodules, and reduce the number of delayed surgeries that may lead to missed opportunities for cure in patients with cancerous nodules.

描述（由申请人提供）：在先前的研究中，我们小组的成员开发了Alchemist，这是一种计算机化的决策支持系统，该系统基于决策模型为患者管理生成患者和现场的特定建议。随后，我们开发了Alchemist-SPN，这是一种基于Web的决策支持系统，用于管理具有孤立肺结节（SPN）的患者，通过将严格开发的决策分析模型与现有的炼金术师架构联系起来，用于基于计算机的决策支持。同时，我们对决策模型进行了统计验证，并表明使用炼金术士SPN的决策支持有可能提高质量调整后的生存，降低成本，并降低患有恶性结节患者的良性结节和不适当的“注意等待”的不必要的手术频率。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；这是一个常见的问题，存在多种可能的管理策略，最佳管理方法取决于测试前的概率，手术并发症的风险，患者偏好和其他因素。在我们竞争续约应用程序的第二次修订中，我们寻求资金继续我们对炼金术士SPN的系统评估。具体来说，我们根据以前应用程序的审阅者的有益反馈修改了目标和方法。修订后的提案包括三个具体的目标：（1）进行严格的可用性测试和同行评审过程，以实现对潜在用户需求高度响应的决策支持系统的设计和完善； （2）确定炼金术士SPN是否有潜力通过进行理想的实验室条件下的肺结节患者的结局，通过进行一项随机，对照试验，该试验比较暴露于Alchemist SPN或静态流动流动型Algorithm后，将医生通过医生对临床小插曲进行比较； （3）通过将决策支持系统集成到SPN管理的临床工作流程中，并在这些环境中对炼金术士SPN进行“炼金术士”的实施研究，以确定临床医生是否会使用决策支持系统并遵守建议。通过实现这些目标，我们不仅将评估用于管理肺结核的高度创新的计算机决策支持系统的性能，而且还根据专家和实验室和临床环境中的临床医生的反馈来改善系统的性能。最终，我们认为，我们使用Alchemist SPN进行计算机化决策支持的方法有可能改善肺结节患者的管理，并且可能广泛适用于胸腔肿瘤学和临床医学中其他具有挑战性的问题。公共卫生相关性本研究旨在评估一种基于计算机的新型系统，用于改善孤立肺结节（或“肺部”）患者的管理，该系统有时代表了可治愈的肺癌形式。通过评估并最终实施该系统，我们旨在减少非癌性肺结节患者不必要的手术的频率，并减少可能导致癌细胞患者治愈机会的延迟手术的数量。