Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention

对实施可互操作 CDS 预防静脉血栓栓塞的 SCALED（Scaling Acceptable CDS）方法进行评估

• 批准号: 10675563
• 负责人: Genevieve B Melton-Meaux
• 金额: $ 97.77万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675563
• 关键词: Evaluation; SCALED; SCaling; AcceptabLE; cDs

ABSTRACT/PROJECT SUMMARY There is a global emphasis and critical need to close the patient-centered outcomes research (PCOR) evidence to practice gap. Forty percent of patients do not receive evidence-based practice, 20% receive unnecessary or potentially harmful care, and sadly, the list continues. We believe interoperable clinical decision support (CDS) is an indispensable solution to help close this gap; however, poor design, lack of interoperability, and implementation barriers hinder broad adoption. At the University of Minnesota, we have extensive experience implementing and scaling user-centered CDS systems, with over 20 use cases scaled each year. Importantly, we have developed and implemented both interoperable and federally-funded CDS systems. Our healthcare system leverages a rigorous approach, SCALED (SCaling AcceptabLE cDs), to guide CDS scaling across the system. But, the current climate of each healthcare system developing “home-grown” CDS for the exact same guidelines is not tenable. Building capabilities to rapidly translate PCOR to the bedside at scale and share interoperable CDS routinely with an updated knowledge base (living evidence synthesis) is necessary. Given this, we partnered with Apervita, developers of a healthcare technology platform for digital quality measurement and decision support, to develop an interoperable clinical practice guideline leveraging CPG-on-FHIR (Fast Healthcare Interoperability Resources) to prevent inpatient COVID-19 venous thromboembolism (VTE). The proposed R18 project will adapt a currently deployed CDS system to also deliver a VTE prevention guideline for adult patients with traumatic brain injury (TBI). We believe this is an ideal PCOR use case given PCORI’s continued effort to combat VTE in trauma and our experience previously implementing this guideline. Our overall goal is to successfully scale, evaluate, and maintain an interoperable TBI CDS across our 4-institution collaborative network. For Aim 1, we will conduct a Hybrid Type 2 randomized stepped wedge effectiveness- implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using RE-AIM. Despite best efforts, it highly likely CDS adoption will vary across each site; Aim 2 will allow us to understand why. In Aim 2, we will evaluate implementation processes across trial sites guided by the EPIS implementation framework (determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date an accepted process for evidence maintenance does not exist. In Aim 3, we will pilot a “Living Guideline” process model for the VTE prevention CDS systems. Ultimately, this project will scale CDS across a diverse collaborative CDS community serving as an important demonstration of this critical healthcare challenge. We will integrate lessons learned for a planned national scaling in collaboration with engagement of U.S. trauma societies. Importantly, we will develop electronic health record (EHR)-specific IT playbooks for integration of interoperable CDS. Finally, we will pilot an approach for the “Living Guideline” and use that to sustain evidenced-based decision logic.

摘要/项目摘要 全球都在强调并迫切需要结束以患者为中心的结果研究 (PCOR) 证据 40% 的患者没有接受基于证据的实践，20% 接受不必要的或 潜在有害的护理，可悲的是，我们相信可互操作的临床决策支持（CDS）仍在继续。 是帮助缩小这一差距的不可或缺的解决方案；然而，设计不佳、缺乏互操作性以及 在明尼苏达大学，实施阻碍了广泛采用。 实施和扩展以用户为中心的 CDS 系统，每年扩展 20 多个用例。 我们开发并实施了可互操作且由联邦政府资助的 CDS 系统。 系统利用严格的方法 SCALED（Scaling Acceptable cD）来指导 CDS 在整个系统中的扩展 但是，当前每个医疗保健系统都在为完全相同的情况开发“本土”CDS。 建立快速将 PCOR 大规模转化到临床并共享的能力是站不住脚的。 具有更新的知识库（活生生的证据合成）的可互操作的 CDS 例程是必要的。 为此，我们与 Apervita 合作，Apervita 是数字质量测量医疗保健技术平台的开发商 和决策支持，利用 CPG-on-FHIR（快速 医疗保健互操作性资源），以预防住院患者 COVID-19 静脉血栓栓塞 (VTE)。 拟议的 R18 项目将采用当前部署的 CDS 系统，以提供 VTE 预防指南 对于患有创伤性脑损伤 (TBI) 的成年患者，考虑到 PCORI，我们认为这是一个理想的 PCOR 用例。 持续努力对抗创伤中的 VTE，以及我们之前实施本指南的经验。 我们的总体目标是在我们的 4 个机构中成功扩展、评估和维护可互操作的 TBI CDS 对于目标 1，我们将进行混合类型 2 随机阶梯楔有效性 - 在 4 个异构医疗保健系统中扩展 CDS 的实施试验将是试验结果。 尽管尽了最大努力，但各个站点的 CDS 采用情况很可能会有所不同； 让我们了解原因 2，我们将在试验地点的指导下评估实施流程。 使用混合方法的 EPIS 实施框架（行列式框架） 最后，至关重要的是 PCOR。 CPG 是随着证据的发展而维护的，迄今为止，还没有公认的证据维护流程。 在目标 3 中，我们将为 VTE 预防 CDS 系统试行“生活指南”流程模型。 最终，该项目将在多元化的协作 CDS 社区中扩展 CDS，作为重要的 我们将整合经验教训以制定全国计划。 重要的是，我们将与美国创伤协会合作开发电子医疗。 用于集成可互操作 CDS 的特定于记录 (EHR) 的 IT 手册 最后，我们将试点一种方法。 “生活指南”并用它来维持基于证据的决策逻辑。