EHR-based Decision Support for Pediatric Acute Abdominal Pain in Emergency Care

基于 EHR 的紧急护理中小儿急性腹痛决策支持

• 批准号: 8818435
• 负责人: Anupam B Kharbanda
• 金额: $ 66.61万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-01 至 2020-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8818435
• 关键词: Abdomen; Abdominal Pain; Accident and Emergency department; Acute; Adolescent; Adult; Age; Appendectomy; Appendicitis; Caring; Child; Child Care; Child Support; Childhood; Clinical; Clinical Decision Support Systems; Cluster randomized trial; Cohort Studies; Communities; Complex; Data; Derivation procedure; Development; Diagnosis; Diagnostic Imaging; Economics; Electronic Health Record; Emergency Care; Emergency Situation; Emergency department visit; Emergency medical service; Emergent care; Ensure; Etiology; Exposure to; Goals; Health; Health Care Costs; Health system; Image; Incidence; Intervention; Investments; Ionizing radiation; Judgment; Link; Measures; Methods; Modeling; Monitor; Online Systems; Operative Surgical Procedures; Outcome; Outpatients; Patients; Perforation; Pilot Projects; Predictive Value; Private Sector; Provider; Public Sector; Research; Resources; Risk; Risk Assessment; Risk Estimate; Safety; Sampling; Site; Source; Symptoms; System; Technology; Time; Translating; Triage; Ultrasonography; United States; Validation; Visit; Work; X-Ray Computed Tomography; adolescent patient; base; care delivery; care seeking; cohort; cost; design; diagnostic accuracy; evidence base; evidence based guidelines; flexibility; high risk; improved; indexing; innovation; pediatric patients; personalized care; point of care; public health relevance; response; standardized care; tool

DESCRIPTION (provided by applicant): Abdominal pain is one of the most common reasons for children and adolescents to seek care in the emergency department (ED). Despite the high incidence, diagnosing appendicitis remains challenging. Computed tomography (CT) has been promoted as a method to improve diagnostic accuracy when evaluating patients with acute abdominal pain. In the past 20 years, CT use has increased dramatically, especially for children receiving care in general ED settings. Although in some adult cohorts, increased CT use has been associated with decreased rates of negative appendectomies, similar improvements in health outcomes among children with acute abdominal pain have not occurred. Negative consequences of CT include increased costs and substantial exposure to ionizing radiation. The proposed intervention, referred to as appy-CDS, is specifically designed for widespread use in EDs and could reduce reliance on advanced diagnostic imaging for pediatric and adolescent patients with acute abdominal pain while maintaining or improving clinical outcomes. This project builds on more than 10 years of work on derivation and validation of ED-based clinical decision rules, previous successful outpatient and emergency department clinical decision support interventions, and complex economic and statistical analyses of risk assessment and ED resource use. In this project, we aim to extend the benefits of our previous efforts by developing and implementing an interactive, evidence-based clinical decision support tool to optimize care for children and adolescents presenting to a general or non-pediatric ED with acute abdominal pain. The results of this project will extend our understanding of how to maximize the clinical return on massive public and private sector investments being made in sophisticated EHR systems. If successful, this flexible decision support tool could be adapted and implemented broadly in a range of acute care settings to both standardize and personalize care delivered to pediatric patients.

描述（由申请人提供）：腹痛是儿童和青少年到急诊科 (ED) 寻求护理的最常见原因之一。尽管发病率很高，诊断阑尾炎仍然具有挑战性。计算机断层扫描（CT）已被推广为一种在评估急性腹痛患者时提高诊断准确性的方法。在过去 20 年中，CT 的使用急剧增加，特别是对于在普通急诊室接受护理的儿童而言。尽管在一些成人队列中，CT 使用的增加与阑尾切除术阴性率的降低有关，但急性腹痛儿童的健康结果并未出现类似的改善。 CT 的负面后果包括成本增加和大量暴露于电离辐射。拟议的干预措施被称为 appy-CDS，专为在急诊科广泛使用而设计，可以减少患有急性腹痛的儿科和青少年患者对先进诊断成像的依赖，同时维持或改善临床结果。该项目建立在 10 多年基于 ED 的临床决策规则的推导和验证工作、之前成功的门诊和急诊科临床决策支持干预措施以及风险评估和 ED 资源使用的复杂经济和统计分析的基础上。在这个项目中，我们的目标是通过开发和实施一种交互式、基于证据的临床决策支持工具来扩展我们之前的努力的好处，以优化对患有急性腹痛的普通或非儿科急诊科的儿童和青少年的护理。该项目的结果将加深我们对如何最大限度地提高公共和私营部门在复杂的 EHR 系统中进行的大规模投资的临床回报的理解。如果成功，这种灵活的决策支持工具可以在一系列急症护理环境中广泛采用和实施，以标准化和个性化为儿科患者提供的护理。