Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool.
Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool.
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DOI：
10.2196/25192
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发表时间：
2021-11-16
影响因子：
7.4
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Amin S;Gupta V;Du G;McMullen C;Sirrine M;Williams MV;Smyth SS;Chadha R;Stearley S;Li J
晕厥的评估和管理与测试过度使用和不必要的住院治疗有关。2017年美国心脏病学会/美国心脏协会（ACC/AHA）晕厥指南旨在规范临床实践并减少不必要的服务。临床决策支持（CDS）工具的使用提供了成功实施循证临床指南的可能性。然而，目前缺乏在护理点提供晕厥的循证鉴别诊断（DDx）的CDS工具。在不同卫生系统的输入下，我们开发并证明了一个移动的应用程序的可行性，即通过脑卒中（MISSION）晕厥进行晕厥视光学护理的多层次实施策略，作为晕厥诊断和预后的CDS工具。该应用程序的开发有三个主要目标：（1）可靠地生成准确的DDx，（2）结合基于证据的临床风险工具进行预后，以及（3）基于用户的设计和技术开发。为了生成包含评估建议的DDx，我们回顾了指南和文献，以确定临床评估问题（变量）和预测病因的每个变量的似然比（LHR）。应用诊断的创建和验证是通过反复的临床医生审查和实际临床病例的应用进行的。现有的风险评分计算器的审查重点是确定一个易于应用和有效的循证临床风险分层工具。审查和决策因素包括原始研究的特征、临床变量和验证研究。应用程序的设计和开发依赖于以用户为中心的设计原则。我们使用急诊科工作流程的观察、故事板演示、多个模拟审查会议和beta测试来优化功能和可用性。MISSION Syncope应用程序符合循证实践（EBP）的指南建议，其用户界面（UI）反映了真实世界患者评价的步骤：评估、DDx、风险分层和建议。该应用程序提供灵活的临床决策，同时强调护理连续性;它根据用户输入生成诊断和预后建议。应用程序中的DDx被认为是一种实用的模型，与现实世界的临床实践更紧密地结合在一起，并使用实际的临床病例进行了验证。该应用程序的beta测试证明了该晕厥CDS工具的功能和可用性。MISSION Syncope应用程序开发整合了当前文献和临床专业知识，以提供循证DDx、使用经验证的评分系统的预后以及基于临床指南的建议。该应用程序展示了在CDS工具的开发中使用研究文献的重要性，并应用临床经验来填补现有研究的空白。对于一个成功的应用程序来说，考虑到现有的已发表证据，刻意追求实用的临床模型而不是追求完美的数学模型是至关重要的。这种混合方法可以应用到类似的CDS工具的开发。
Syncope evaluation and management is associated with testing overuse and unnecessary hospitalizations. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guideline aims to standardize clinical practice and reduce unnecessary services. The use of clinical decision support (CDS) tools offers the potential to successfully implement evidence-based clinical guidelines. However, CDS tools that provide an evidence-based differential diagnosis (DDx) of syncope at the point of care are currently lacking. With input from diverse health systems, we developed and demonstrated the viability of a mobile app, the Multilevel Implementation Strategy for Syncope optImal care thrOugh eNgagement (MISSION) Syncope, as a CDS tool for syncope diagnosis and prognosis. Development of the app had three main goals: (1) reliable generation of an accurate DDx, (2) incorporation of an evidence-based clinical risk tool for prognosis, and (3) user-based design and technical development. To generate a DDx that incorporated assessment recommendations, we reviewed guidelines and the literature to determine clinical assessment questions (variables) and likelihood ratios (LHRs) for each variable in predicting etiology. The creation and validation of the app diagnosis occurred through an iterative clinician review and application to actual clinical cases. The review of available risk score calculators focused on identifying an easily applied and valid evidence-based clinical risk stratification tool. The review and decision-making factors included characteristics of the original study, clinical variables, and validation studies. App design and development relied on user-centered design principles. We used observations of the emergency department workflow, storyboard demonstration, multiple mock review sessions, and beta-testing to optimize functionality and usability. The MISSION Syncope app is consistent with guideline recommendations on evidence-based practice (EBP), and its user interface (UI) reflects steps in a real-world patient evaluation: assessment, DDx, risk stratification, and recommendations. The app provides flexible clinical decision making, while emphasizing a care continuum; it generates recommendations for diagnosis and prognosis based on user input. The DDx in the app is deemed a pragmatic model that more closely aligns with real-world clinical practice and was validated using actual clinical cases. The beta-testing of the app demonstrated well-accepted functionality and usability of this syncope CDS tool. The MISSION Syncope app development integrated the current literature and clinical expertise to provide an evidence-based DDx, a prognosis using a validated scoring system, and recommendations based on clinical guidelines. This app demonstrates the importance of using research literature in the development of a CDS tool and applying clinical experience to fill the gaps in available research. It is essential for a successful app to be deliberate in pursuing a practical clinical model instead of striving for a perfect mathematical model, given available published evidence. This hybrid methodology can be applied to similar CDS tool development.
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与ED访问有关的晕厥访问相关的资源利用率的国家趋势。
DOI：
10.1016/j.ajem.2015.04.030
发表时间：
2015-08
期刊：
The American journal of emergency medicine
影响因子：
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作者：
Probst MA;Kanzaria HK;Gbedemah M;Richardson LD;Sun BC
通讯作者：
Sun BC
DOI：
10.1016/j.ajem.2020.05.029
发表时间：
2020-09
期刊：
The American journal of emergency medicine
影响因子：
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作者：
Li J;Gupta V;Smyth SS;Cowley A;Du G;Sirrine M;Stearley S;Chadha R;Bhalla V;Williams MV
通讯作者：
Williams MV
影响因子：
2.8
作者：
Del Rosso, A;Alboni, P;Raviele, A
通讯作者：
Raviele, A
影响因子：
3.5
作者：
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通讯作者：
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影响因子：
6.2
作者：
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通讯作者：
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