Development of Single-Screen Clinical Decision Support to Increase Guideline-Based Weight Management and Comorbidity Care

开发单屏临床决策支持以加强基于指南的体重管理和合并症护理

• 批准号: 9789921
• 负责人: Christy Boling Turer
• 金额: $ 8.1万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789921
• 关键词: Address; Adult; Age; Algorithms; Blood Pressure; Cardiovascular Diseases; Caring; Child; Childhood; Cognitive; Communication; Comorbidity; Complex; Conflict (Psychology); Consensus; Decision Support Model; Decision Support Systems; Decision Trees; Detection; Development; Diagnosis; Diagnostic; Diet; Electronic Health Record; Elements; Engineering; Evaluation; Fast Healthcare Interoperability Resources; Funding; Future; Gender; Goals; Guidelines; Health; Healthcare; Heart Diseases; Height; Hypertension; Informatics; Information Specialists; Internet; Intervention; Laboratory Study; Lead; Life Style; Medicine; Methods; Morbidity - disease rate; Obesity; Obesity Related Hypertension; Obesity associated disease; Overweight; Patients; Pharmaceutical Preparations; Plant Roots; Population; Primary Health Care; Provider; Psyche structure; Publishing; Recommendation; Research; Resistance; Risk Factors; Structure; Techniques; Testing; Time; Update; Variant; Weight; Weight maintenance regimen; Work; base; blood pressure regulation; care delivery; care providers; clinical decision support; clinical practice; computerized; dashboard; disorder prevention; follow-up; heart disease risk; hypertension treatment; improved; operation; pediatrician; point of care; satisfaction; screening; screening guidelines; support tools; symposium; task analysis; tool; Address; Adult; Age; Algorithms; Blood Pressure; Cardiovascular Diseases; Caring; Child; Childhood; Cognitive; Communication; Comorbidity; Complex; Conflict (Psychology); Consensus; Decision Support Model; Decision Support Systems; Decision Trees; Detection; Development; Diagnosis; Diagnostic; Diet; Electronic Health Record; Elements; Engineering; Evaluation; Fast Healthcare Interoperability Resources; Funding; Future; Gender; Goals; Guidelines; Health; Healthcare; Heart Diseases; Height; Hypertension; Informatics; Information Specialists; Internet; Intervention; Laboratory Study; Lead; Life Style; Medicine; Methods; Morbidity - disease rate; Obesity; Obesity Related Hypertension; Obesity associated disease; Overweight; Patients; Pharmaceutical Preparations; Plant Roots; Population; Primary Health Care; Provider; Psyche structure; Publishing; Recommendation; Research; Resistance; Risk Factors; Structure; Techniques; Testing; Time; Update; Variant; Weight; Weight maintenance regimen; Work; base; blood pressure regulation; care delivery; care providers; clinical decision support; clinical practice; computerized; dashboard; disorder prevention; follow-up; heart disease risk; hypertension treatment; improved; operation; pediatrician; point of care; satisfaction; screening; screening guidelines; support tools; symposium; task analysis; tool

PROJECT SUMMARY Obesity-related hypertension is now diagnosed in children. If undiagnosed and untreated, hypertension increases the likelihood of serious health consequences. To address this problem, we must prepare pediatricians, once focused on anticipatory guidance and disease prevention, to surveil and treat children with overweight and obesity for high blood pressure and hypertension. Because blood-pressure norms in children vary with age, gender, and height, it is difficult to identify three blood-pressure elevations to diagnose hypertension. Our long-term goals are to: 1) identify how to support pediatricians in this major practice paradigm shift, 2) improve delivery of guideline-based weight-management and hypertension care, 3) improve long-term weight management, and 4) reduce morbidity from unrecognized obesity-related disease. Our previous studies revealed: (1) specific guideline-recommended weight management clinical practices are effective, but too-rarely used, (2) providers fail to recognize elevated blood pressures in overweight children, (3) determining pediatric hypertension criteria is a complex, error-prone task, and (4) this impediment to hypertension care can be removed by hypertension clinical decision support. These results led us to ask if we could collate and present to providers information needed to deliver both guideline-based weight management and hypertension care. However, in drafting a potential decision-support system, we confronted age and weight-status variations in screening and evaluation guidelines for weight management and hypertension. This led to our central hypothesis that: (1) expert consensus will resolve conflicts and coordinate guideline-based recommendations for weight management and hypertension care, and (2) application of cognitive-engineering methods currently underused in medicine will enable us to build a single-screen weight- management plus hypertension clinical-decision-support interface that is: (1) easy to use (reduces number of task steps needed), (2) error-resistant (limits number of cognitively demanding steps, including mental calculations and recall), and (3) helpful for efficiently identifying and taking action on key information needed to deliver guideline-based weight-management and hypertension care. Our proposed research will broadly impact the field by transforming the current primary-care weight- management clinical practice paradigm to include guideline-based hypertension care. If successful, the resulting clinical-decision-support model can be applied in the future to address other obesity-related comorbidities. Through future funding, the fully developed tool will be used to test whether weight-management plus hypertension clinical decision support improves weight and blood-pressure control. This work holds great potential to support pediatricians in a major practice paradigm shift and delivery of guideline-based weight management and hypertension care. Delivery of this care holds great potential for reducing future cardiovascular disease in adulthood from unrecognized, untreated obesity and hypertension in children.

项目摘要 现在在儿童中诊断出与肥胖有关的高血压。如果未诊断和未经治疗，高血压 增加了严重健康后果的可能性。要解决这个问题，我们必须准备 曾经专注于预期指导和疾病的儿科医生，以监视和治疗儿童 高血压和高血压超重和肥胖。因为儿童的血压规范 随着年龄，性别和身高而变化，很难识别三个血压高程以诊断 高血压。我们的长期目标是：1）确定如何在这一主要实践中支持儿科医生 范式移动，2）改善基于指南的权重管理和高血压护理的交付，3）改进 长期体重管理和4）减少与肥胖相关疾病的发病率。 我们先前的研究表明：（1）特定指南示出的体重管理临床实践 （2）提供者在超重中无法识别出升高的血压 儿童，（3）确定小儿高血压标准是一项复杂，容易出错的任务，（4）这种障碍 高血压临床决策支持可以消除高血压护理。这些结果使我们问 我们可以整理并提供给提供两种基于指南的权重的提供者信息 管理和高血压护理。但是，在起草潜在的决策支持系统时，我们面对了 体重管理筛查和评估指南的年龄和体重代表变化 高血压。这导致了我们的中心假设：（1）专家共识将解决冲突并协调 基于指南的体重管理和高血压护理建议，以及（2）应用 当前在医学领域没有用途的认知工程方法将使我们能够建立单屏重量 - 管理加上高血压临床抑制界面界面：（1）易于使用（减少数量 所需的任务步骤），（2）抗错（限制认知要求的步骤数，包括心理 计算和召回），以及（3）有助于有效识别和采取对所需的关键信息的行动 提供基于指南的权重管理和高血压护理。 我们提出的研究将通过改变当前的一级护理权重，从而广泛影响该领域。 管理临床实践范式包括基于指南的高血压护理。如果成功， 将来可以应用最终的临床支持模型来解决其他与肥胖有关的问题 合并症。通过将来的资金，将使用全面开发的工具来测试是否重量管理 加上高血压临床决策支持可以改善体重和血压控制。这项工作很棒 在重大实践范式转移和基于指南的重量的主要实践范式中支持儿科医生的潜力 管理和高血压护理。提供此护理的交付具有减少未来的巨大潜力 儿童未识别，未经治疗的肥胖症和高血压的成年后心血管疾病。