Clinical Decision Support for Mild Traumatic Brain Injury

轻度创伤性脑损伤的临床决策支持

• 批准号: 9053440
• 负责人: Edward Robert Melnick
• 金额: $ 15.4万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-09 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9053440
• 关键词: Clinical; Decision; Support; Mild; Traumatic

DESCRIPTION (provided by applicant): CANDIDATE: Dr. Edward R. Melnick is an Assistant Professor in the Department of Emergency and currently a student in the Master of Health Science Degree program with Clinical Informatics Track at the Yale University School of Medicine. His research focuses on improving clinical practice guideline implementation using computerized Clinical Decision Support (CDS). Traditional CDS consists of alerts or reminders presented to the clinician regarding patient-specific recommendations. Dr. Melnick has a track record for scholarly productivity with 13 peer-reviewed publications over the last five years. He is also an active member of the national clinical practice guideline development group for emergency medicine. The long-term goal of Dr. Melnick's research program is to become an independent investigator whose research program is aimed at changing the acute care clinical encounter paradigm by developing systematic patient-centered methods that promote transparent, shared, informed decision-making to safely reduce resource utilization. He plans to devote his career to overcoming the design challenges to effective CDS thus incorporating CDS that is useful, usable, promotes shared decision-making, and is seamlessly integrated into clinical workflow. Dr. Melnick's design innovations will change the way that health care is delivered and, subsequently, achieve a significant impact on patient outcomes, health care quality, safety, efficiency, costs, and effectiveness for all Americans. ENVIRONMENT & MENTOR: The Department of Emergency Medicine at the Yale University School of Medicine offers a fertile environment for physician-scientists committed to clinical research. The Department and University offer abundant research support and resources for professional development and research excellence. During the proposed award, Dr. Melnick will develop his skills by completing: (1) his ongoing master's of health science degree program with clinical informatics track, (2) formal coursework in human- computer interaction, medical decision-making, databases, and clinical information systems, and (3) goal- directed training activities in CDS, cognitive task analysis, human factors engineering, qualitative research methods, and implementation science under the mentorship of Drs. Shiffman and Post. Dr. Shiffman, Professor and Associate Director for the Yale Center for Medical Informatics, is a well-established researcher whose work focuses on defining systematic and replicable processes by which guideline knowledge can be translated into CDS. Dr. Post, Associate Professor and Research Director of Emergency Medicine at Yale, is an expert in Health Information Technology research using qualitative and mixed methods including experiences with focus groups, survey research, and usability testing. RESEARCH PROJECT: The objective of this project is to pilot an innovative CDS design process that produces patient-centered, useful, and usable CDS for the management of minor head injury in the emergency department (ED). The ED is the ideal setting to study overuse of diagnostic imaging as imaging rates of injured patients have tripled over ten years without a measurable improvement in patient outcomes, despite implementation of highly sensitive and specific clinical decision rules for detecting clinically important brain injury in minor head injury patients. Evidence-based best practices face barriers to implementation including: lack of awareness, agreement, and adherence. CDS offers a promising strategy to improve guideline implementation. Despite forty years of implementation attempts, CDS has not been universally adopted nor have its benefits been fully realized. Several adoption barriers have been identified with the primary challenge being the "usefulness" (whether it accomplishes its objective) and "usability" (ease-of-use) of the CDS due to poor integration into clinical workflow. This investigation will rely on qualitative methods to identify factors that promote or inhibit the appropriate use of computed tomography (CT) in patients presenting to the ED with minor head injury. Qualitative factors identified in this analysis will b integrated into the design of a patient- centered decision support tool prototype for use by patients and their provider at the bedside. This tool will undergo iterative refinement via rigorou usability testing in the usability lab and the ED in order to maximize its usefulness, efficiency, ease-of-use, user satisfaction, integration into clinical workflow, and ability to promote shared decision-making regarding the appropriate use of CT. The feasibility of implementing this patient- centered decision support at the bedside in a high-volume ED will be provide data for the subsequent clinical trial. The data generated from this pilot is critical to take my research program to the next level-an effectiveness study of the patient-centered decision support tool to safely reduce CT use. This proposal fulfills the Agency for Healthcare Research and Quality (AHRQ) research priority of training investigators in health information technology to improve health care decision-making and support patient-centered care. It will be piloted in the Yale-New Haven ED whose patients include an inner-city population with large minority and low- income groups-two AHRQ priority populations. The tool will include special provisions for shared decision- making with the elderly, another AHRQ priority population.

描述（由申请人提供）：候选人：Edward R. Melnick博士是紧急部门的助理教授，目前是耶鲁大学医学院临床信息学轨道硕士硕士学位课程的学生。他的研究重点是使用计算机化临床决策支持（CD）改善临床实践指南实施。传统的CD由向临床医生提出的有关患者特定建议的警报或提醒组成。梅尔尼克博士在过去五年中拥有13个同行评审的出版物的学术生产力记录。他还是国家临床实践指南急诊医学发展小组的活跃成员。梅尔尼克（Melnick）研究计划的长期目标是成为一名独立研究者，其研究计划旨在通过开发系统以患者为中心的方法来改变急性护理临床遭遇范式，从而促进透明，共享，知情的决策，以安全地减少资源利用。他计划致力于克服有效CD的设计挑战，从而结合了有用，可用的CD，可促进共同的决策，并无缝整合到临床工作流程中。 Melnick博士的设计创新将改变提供医疗保健的方式，并随后对所有美国人的卫生保健质量，安全性，效率，成本和有效性产生重大影响。环境与导师：耶鲁大学医学院急诊医学系为致力于临床研究的医师科学家提供了肥沃的环境。该系和大学为专业发展和卓越研究提供了丰富的研究支持和资源。 During the proposed award, Dr. Melnick will develop his skills by completing: (1) his ongoing master's of health science degree program with clinical informatics track, (2) formal coursework in human- computer interaction, medical decision-making, databases, and clinical information systems, and (3) goal- directed training activities in CDS, cognitive task analysis, human factors engineering, qualitative research methods, and implementation science under the mentorship of Drs. Shiffman和Post。耶鲁大学医学信息学中心教授兼副主任Shiffman博士是一位知名的研究人员，其工作重点是定义系统和可复制的过程，可以将指南知识转化为CD。耶鲁大学副教授兼急诊医学研究总监Post博士是健康信息技术研究专家，使用定性和混合方法，包括焦点小组的经验，调查研究和可用性测试。研究项目：该项目的目的是试行创新的CD设计过程，该过程产生以患者为中心，有用且可用的CD，用于管理急诊科（ED）的轻微头部受伤。 ED是研究过度使用诊断成像的理想场所，因为受伤患者的成像率已有两倍多，但没有可测量地改善患者的结果，尽管实施了高度敏感和特定的临床决策规则，用于检测轻度头部损伤患者临床上重要的脑损伤。循证最佳实践面对 实施的障碍包括：缺乏意识，同意和遵守。 CD提供了一种有希望的策略来改善指南实施。尽管实施了40年，但CD尚未普遍采用，也没有充分实现其利益。主要的挑战已经确定了几个采用障碍，这是“有用性”（是否实现其目标）和CD的“可用性”（易用性），这是由于不良整合到临床工作流程中而导致的。这项调查将依靠定性方法来识别 促进或抑制适当使用计算机断层扫描（CT）的因素，在急诊室受到轻微损伤的患者中。在此分析中确定的定性因素将B集成到患者中心的决策支持工具原型的设计中，以供患者及其在床边使用。该工具将通过可用性实验室和ED中的严重可用性测试进行迭代完善，以最大程度地提高其有用性，效率，易用性，用户满意度，集成到临床工作流程中，以及促进有关CT适当使用的共同决策的能力。在高量ED中在床边实施此中心的决策支持的可行性将为随后的临床试验提供数据。该试验产生的数据对于将我的研究计划带入下一个级别的有效性研究至关重要 - 以患者为中心的决策支持工具可以安全地减少CT使用。该建议履行了医疗保健研究与质量（AHRQ）的研究优先级的健康信息技术研究人员，以改善医疗保健决策并支持以患者为中心的护理。它将在耶鲁大学新的避风港中进行驾驶，其患者包括少数群体和低收入群体的城市人口，两国优先人口。该工具将包括与另一个AHRQ优先人群的老年人共享决策的特殊规定。