Health IT-supported process for preventing and managing VTE

健康 IT 支持的 VTE 预防和管理流程

• 批准号: 8739635
• 负责人: PASCALE CARAYON
• 金额: $ 49.87万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8739635
• 关键词: Health; supported; process; preventing; managing; Health; supported; process; preventing; managing

DESCRIPTION (provided by applicant): Venous thromboembolism (VTE) remains a frequent, but preventable complication for hospitalized patients that can lead to significant morbidity and mortality. It has been estimated that more than 900,000 VTE cases occur in the US every year. A range of VTE prevention interventions have been evaluated, such as electronic reminders and clinical decision support (CDS) for VTE risk assessment. Health information (IT) may provide an opportunity for improving the prevention and management of VTE. However, studies of electronic alerts based on computerized VTE risk assessment have produced limited benefits. These studies have been restricted to high-risk patients, have focused on prophylaxis (i.e. VTE prevention) with little or no consideration for VTE diagnosis and treatment (i.e. VTE management), and have not addressed sociotechnical challenges related to CDS design identified in numerous reports. We propose to use a sociotechnical systems approach to the design of health IT specifically for preventing and managing VTE; this approach can address the range of sociotechnical system issues that have limited the effectiveness of health IT for VTE. Using the SEIPS model and the human factors multi-level system model, we will develop a deep understanding of the cognitive and team work involved in VTE prevention and management, and then use the outputs of this analysis to define sociotechnical design requirements for a CDS that supports cognitive and team work for preventing and managing VTE. Our specific aims are: (1) to evaluate the cognitive and team work involved in VTE prevention and management; and (2) to develop design requirements for a CDS that supports cognitive and team work for preventing and managing VTE. The study will be conducted in four hospitals of an integrated healthcare system. Methods for analyzing cognitive and team work will be diverse (i.e. observation, interview, focus group and survey) (Aim 1) and will produce a range of outputs (e.g., decision ladders, process map, information flow diagram) that will be used to define the CDS design requirements (Aim 2). Using a collaborative process between the human factors engineers and the physicians on the research team, we will develop preliminary design requirements that will be embedded in CDS mock-ups; the CDS mock-ups will then be evaluated through scenario-based usability evaluation and group debriefings. The results of this analysis will help to define additional questions to address in the data collection for Aim 1. When all Aim 1 data have been collected and analyzed, we will finalize the CDS design requirements (Aim 2). This research focuses on VTE, but the broader objective is to develop an approach to design health IT applications for healthcare quality and safety problems that can benefit from improved integration of guidelines in clinical workflows. This study is significant and innovative because we are (a) addressing a common, but preventable complication, i.e. VTE; (b) using a sociotechnical systems approach and human factors principles and methods to design health IT; and (c) involving a highly experienced multidisciplinary team of human factors engineers and physicians.

描述（由申请人提供）：静脉血栓栓塞（VTE）仍然是一种常见但可预防的并发症，这可能导致明显的发病率和死亡率。据估计，每年在美国发生了90万VTE案件。已经评估了一系列VTE预防干预措施，例如电子提醒和临床决策支持（CD）进行VTE风险评估。健康信息（IT）可能会为改善VTE的预防和管理提供机会。但是，基于计算机化VTE风险评估的电子警报的研究产生了有限的收益。这些研究仅限于高风险患者，专注于预防（即预防VTE），几乎没有考虑VTE诊断和治疗（即VTE管理），并且没有解决与许多报告中确定的与CDS设计相关的社会技术挑战。我们建议使用一种专门用于预防和管理VTE的健康设计的社会技术系统方法；这种方法可以解决限制VTE健康有效性的社会技术系统问题。使用SEIP模型和人为因素多级系统模型，我们将对参与VTE预防和管理涉及的认知和团队工作有深入的了解，然后使用该分析的输出来定义社会技术设计要求，以支持认知和团队为预防和管理VTE而努力的CDS。我们的具体目的是：（1）评估预防和管理中涉及的认知和团队工作； （2）为支持认知和团队工作以防止和管理VTE的CD制定设计要求。该研究将在四个综合医疗系统的医院中进行。分析认知和团队合作的方法将是多种多样的（即观察，访谈，焦点小组和调查）（AIM 1），并将产生一系列输出（例如，决策阶梯，过程图，信息流程图）将用于定义CDS设计要求（AIM 2）。使用人为因素工程师和研究团队的医生之间的协作过程，我们将开发将嵌入CDS模型中的初步设计要求；然后，将通过基于方案的可用性评估和组汇报来评估CDS模型。该分析的结果将有助于定义AIM 1的数据收集中要解决的其他问题。 所有目标1数据都已收集和分析，我们将最终确定CDS设计要求（AIM 2）。这项研究的重点是VTE，但更广泛的目标是开发一种针对医疗保健质量和安全问题设计健康IT应用的方法，这些方法可以从改善临床工作流程中的准则整合中受益。这项研究具有重要意义和创新性，因为我们（a）解决了常见但可预防的并发症，即VTE； （b）使用社会技术系统方法和人为设计健康IT的原则和方法； （c）涉及一个经验丰富的多学科人为因素工程师和医生的团队。