Improving Guideline Development and Implementation

改进指南的制定和实施

基本信息

批准号：
7799210
负责人：
RICHARD N SHIFFMAN
金额：
$ 38.93万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2002
资助国家：
美国
起止时间：
2002-03-01 至 2012-02-28
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): A longstanding informatics challenge has been to develop efficient mechanisms whereby valid medical knowledge - such as that contained in practice guidelines - can be operationalized in systems that support decision making by clinicians. However, a frustrating impediment to the satisfaction of this goal has been the difficulty of translation of guideline knowledge into computable formats. In this competing renewal application we propose a research program that will extend successful accomplishments. 1. Recognizing that vague and ambiguous recommendations impede both guideline implementation and adherence, we will model and characterize the forms of ambiguity and vagueness that are prevalent in guideline statements, ascertain the degree to which such statements lead to clinical uncertainty, and identify methods to diminish this uncertainty. 2. In collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians, we will develop, install, and evaluate software tools that support efficient authoring of scientifically valid and implementable guidelines. Working with the national professional societies offers an opportunity to move the tools and techniques developed in the last grant period into the real world where they will be evaluated and iteratively improved. 3. We will facilitate implementation of guideline knowledge by developing tools to help translate natural language recommendations into formal rules and apply a framework based on action-types to design reusable implementation strategies that can be used at national and local levels. 4. We will modify and further extend the Guideline Elements Model to accommodate concepts that are critical for guideline document modeling, authoring, and implementation activities. We will create an XML Schema and provide capabilities to current users to assure their GEM files remain compatible. Furthermore, we will submit the new model as a proposed standard to HL7 and/or ASTM. A systematic process for translating guideline knowledge into operational decision support systems can have substantial benefits for delivery of high-quality, evidence based health care. In addition, the proposed activities focus on systems that will preferentially impact children - a particularly vulnerable population.

描述（由申请人提供）：长期存在的信息学挑战是开发有效的机制，使有效的医学知识（例如实践指南中包含的知识）可以在支持临床医生决策的系统中得到操作。然而，实现这一目标的一个令人沮丧的障碍是将指南知识转化为可计算格式的困难。在这个竞争性更新申请中，我们提出了一项研究计划，该计划将扩展成功的成就。 1. 认识到模糊和模棱两可的建议会阻碍指南的实施和遵守，我们将对指南陈述中普遍存在的模棱两可和含糊不清的形式进行建模和表征，确定此类陈述导致临床不确定性的程度，并确定减少指南陈述的方法。这种不确定性。 2. 我们将与美国儿科学会和美国家庭医师学会合作，开发、安装和评估软件工具，以支持高效编写科学有效且可实施的指南。与国家专业协会合作提供了将上一个资助期开发的工具和技术转移到现实世界的机会，在那里它们将被评估和迭代改进。 3. 我们将通过开发工具来帮助将自然语言建议转化为正式规则，并应用基于行动类型的框架来设计可在国家和地方层面使用的可重复使用的实施策略，从而促进指南知识的实施。 4. 我们将修改并进一步扩展指南元素模型，以适应对于指南文档建模、创作和实施活动至关重要的概念。我们将创建一个 XML 架构并为当前用户提供功能，以确保他们的 GEM 文件保持兼容。此外，我们将把新模型作为提议标准提交给 HL7 和/或 ASTM。将指南知识转化为操作决策支持系统的系统过程可以为提供高质量、基于证据的医疗保健带来巨大好处。此外，拟议的活动重点关注将优先影响儿童（特别弱势群体）的系统。