Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection
Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection
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DOI：
10.1197/jamia.m3196
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发表时间：
2010-01-01
影响因子：
6.4
通讯作者：
Trick, William
中科院分区：
文献类型：
--
作者：
Hota, Bala;Lin, Michael;Trick, William
目的 制定一个模型，将手动感染控制监视方法转化为自动化的算法方法。设计 我们提出了一种通过将现有的手动监视实践转化为自动化电子方法来创建电子监视算法的模型。我们的模型建议参考三个维度的专家知识：临床、监测和信息学。一旦收集完毕，知识应该通过概念化、综合、编程和测试的过程来应用。结果我们将我们的框架应用于中心血管导管相关的血流感染监测，这是一项主要的医疗保健绩效结果衡量标准。我们发现，尽管存在结构化数据可用性、使用的数据库类型和临床术语语义表示方面的差异等主要障碍，但血流感染检测算法可以在四个非常不同的医疗中心部署。结论我们提出了一个框架，将现有的实践手动感染检测转化为自动化监测过程。我们的经验详细介绍了四家医院在各种数据环境中开发中央血管导管相关血流感染电子监测过程中发现的障碍和解决方案。通过将必要的数据元素、词汇和标准纳入商业电子健康记录中，可以加速将电子监控提升到一个新的水平——全国大多数急症护理医院的可用性。
Objective To formulate a model for translating manual infection control surveillance methods to automated, algorithmic approaches.Design We propose a model for creating electronic surveillance algorithms by translating existing manual surveillance practices into automated electronic methods. Our model suggests that three dimensions of expert knowledge be consulted: clinical, surveillance, and informatics. Once collected, knowledge should be applied through a process of conceptualization, synthesis, programming, and testing.Results We applied our framework to central vascular catheter associated bloodstream infection surveillance, a major healthcare performance outcome measure. We found that despite major barriers such as differences in availability of structured data, in types of databases used and in semantic representation of clinical terms, bloodstream infection detection algorithms could be deployed at four very diverse medical centers.Conclusions We present a framework that translates existing practice-manual infection detection-to an automated process for surveillance. Our experience details barriers and solutions discovered during development of electronic surveillance for central vascular catheter associated bloodstream infections at four hospitals in a variety of data environments. Moving electronic surveillance to the next level-availability at a majority of acute care hospitals nationwide-would be hastened by the incorporation of necessary data elements, vocabularies and standards into commercially available electronic health records.