Development of clinical decision tools for management of diarrhea of children in high and low resource settings

开发资源丰富和匮乏环境下儿童腹泻管理的临床决策工具

基本信息

批准号：
10649542
负责人：
Daniel Ted Leung
金额：
$ 45.28万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-08 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10649542
关键词：
Accident and Emergency department Accounting Acute Diarrhea Age Ambulatory Care Facilities Antibiotics Applied Research Big Data Blood Breast Feeding Canada Caregivers Cause of Death Cessation of life Child Childhood Climate Clinic Clinical Clinical Management Clinical Research Cost Savings Country Data Data Sources Diagnostic Diagnostic tests Diarrhea District Hospitals Electronic Health Record Electronics Emergency Care Emergency research Enteral Ethnic Population Etiology Feces Feedback Fever Focus Groups Goals Guidelines Health Personnel Health care facility Health system Hydration status Income Individual Interview Intrinsic factor Laboratories Methods Modeling Morbidity - disease rate Multi-site clinical study Multicenter Studies North America Patient Care Patients Performance Physicians Pilot Projects Pollution Population Predictive Factor Prevalence Probability Property Recording of previous events Resource-limited setting Resources Risk Factors Sampling Seasons Site Symptoms Syndrome Testing Viral Vomiting Weather antimicrobial clinical application clinical decision support clinical development clinical examination clinical predictive model clinical predictors design diagnostic tool diarrheal disease economic evaluation economic impact ethnic diversity expectation global health health care service utilization implementation design implementation study improved low and middle-income countries low income country mortality pathogen pediatric emergency predictive tools prospective respiratory rural setting smartphone application support tools tool urban setting urgent care

项目摘要

Abstract Diarrheal diseases are the among the leading cause of death in children worldwide, most of which occur in low-income countries. In high-income countries, pediatric diarrhea remains a major utilization of healthcare resources. The cornerstone for management of diarrhea is rehydration, though antimicrobials are beneficial in some instances. Unfortunately, given that treatment is frequently empiric, based mostly on clinical suspicion for bacterial causes, antimicrobials are overused in management of diarrheal illness worldwide. In high-income countries, diagnostic testing is oftentimes overutilized. Thus, there is a need for clinical decision support tools for antimicrobial and diagnostic stewardship in many settings. Current clinical prediction tools are based mostly on patient-intrinsic properties such as the clinical exam and symptom history specific for that patient. We have preliminary data suggesting that the integration of patient-extrinsic data, including climate and seasonality parameters, and population-level pre-test probabilities (from prior patients and prior years’ prevalence), can improve the performance of a clinical prediction model. We also have preliminary data showing the potential for an electronic clinical decision-support tool (eCDST) that estimates diarrheal etiology to decrease antibiotic prescription rates. Our overarching goal is to: 1) improve diarrhea clinical prediction through integration of patient-extrinsic data sources, and 2) explore the potential feasibility and utility of an eCDST, such as a smartphone application or an electronic health record tool. In Aim 1, we will use data from several prospective clinical studies of pediatric diarrhea to build improved clinical prediction models that includes patient-extrinsic data sources. In Aim 2, we will determine the potential feasibility, utility, and economic impact of an eCDST for antibiotic and diagnostic stewardship by examining clinican and caregiver perspectives through in-depth interviews and focus groups. We will also perform an economic evaluation of eCDST in a US setting. Completion of the Aims will result in an optimized clinical prediction model using big data and lay the groundwork needed to inform the design of implementation studies of eCDSTs for management of pediatric diarrhea.

抽象的腹泻病是全世界儿童死亡的主要原因之一，其中大多数发生在在低收入国家，小儿腹泻仍然是医疗保健的主要用途。治疗腹泻的基石是补液，尽管抗菌药物在这方面是有益的。不幸的是，鉴于治疗通常是经验性的，主要基于临床怀疑。由于细菌原因，全球高收入人群在治疗腹泻疾病时过度使用抗菌药物。在一些国家，诊断测试常常被过度利用，因此需要临床决策支持工具。目前的临床预测工具主要基于许多环境中的抗菌和诊断管理。我们有关于患者固有属性的信息，例如该患者的临床检查和症状史。初步数据表明，患者外在数据（包括气候和季节性）的整合参数和人群水平的预测试概率（来自之前的患者和前几年的患病率），可以提高临床预测模型的性能我们还有初步数据显示其潜力。电子临床决策支持工具 (eCDST)，可估计腹泻病因以减少抗生素使用我们的总体目标是：1）通过整合改善腹泻临床预测。患者外在数据源，2) 探索 eCDST 的潜在可行性和实用性，例如在目标 1 中，我们将使用来自多个预期的数据。腹泻儿科临床研究，以建立改进的临床预测模型，其中包括患者外源性在目标 2 中，我们将确定 eCDST 的潜在可行性、效用和经济影响。通过深入检查临床医生和护理人员的观点来进行抗生素和诊断管理我们还将在美国环境中对 eCDST 进行经济评估。目标的完成将产生利用大数据的优化临床预测模型，并奠定儿科管理 eCDST 实施研究设计所需的基础工作腹泻。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature.

南亚不当使用抗菌药物的驱动因素：定性文献的系统回顾。

DOI：
发表时间：
2023-09-29
期刊：
影响因子：
0
作者：
Murray, Jennifer L;Leung, Daniel T;Hanson, Olivia R;Ahmed, Sharia M;Pavia, Andrew T;Khan, Ashraful I;Szymczak, Julia E;Vaughn, Valerie M;Patel, Payal K;Biswas, Debashish;Watt, Melissa H
通讯作者：
Watt, Melissa H

Qualitative Assessment of a Smartphone-Based Mobile Health Tool to Guide Diarrhea Management in Bangladesh.

对基于智能手机的移动健康工具进行定性评估，以指导孟加拉国的腹泻管理。

DOI：
发表时间：
2024-01-03
期刊：
影响因子：
0
作者：
Biswas, Debashish;Asadullah, Asadullah;Khan, Sazzad Hossain;Khan, Zahid Hasan;Islam, Md Taufiqul;Khan, Ashraful Islam;Qadri, Firdausi;Nelson, Eric J;Watt, Melissa H;Leung, Daniel T
通讯作者：
Leung, Daniel T

Assessment of Model Estimated and Directly Observed Weather Data for Etiological Prediction of Diarrhea.

评估用于腹泻病因预测的模型估计和直接观测的天气数据。

DOI：
发表时间：
2023-10-13
期刊：
影响因子：
0
作者：
Brintz BJ;Colston JM;Ahmed SM;Chao DL;Zaitschik B;Leung DT
通讯作者：
Leung DT

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature.

南亚不当使用抗菌药物的驱动因素：定性文献的系统回顾。

DOI：
发表时间：
2023-09-29
期刊：
影响因子：
0
作者：
Murray JL;Leung DT;Hanson OR;Ahmed SM;Pavia AT;Khan AI;Szymczak JE;Vaughn VM;Patel PK;Biswas D;Watt MH
通讯作者：
Watt MH

Derivation and External Validation of a Clinical Prediction Model for Viral Diarrhea Etiology in Bangladesh.

孟加拉国病毒性腹泻病因临床预测模型的推导和外部验证。

DOI：
发表时间：
2023-07
期刊：
影响因子：
4.2
作者：
Garbern, Stephanie Chow;Islam, Md Taufiqul;Islam, Kamrul;Ahmed, Sharia M;Brintz, Ben J;Khan, Ashraful Islam;Taniuchi, Mami;Platts;Qadri, Firdausi;Leung, Daniel T
通讯作者：
Leung, Daniel T