Implementation of a Novel Multi-Platform Evidence-Based Clinical Decision Support System

项目摘要 静脉血栓栓塞症(VTE)，包括深静脉血栓形成(DVT)和肺血栓形成 栓塞症(PE)是一种致命的疾病，在总人口中有14%的人在30天和一年内死亡 和29%。这种担忧随着最近的大流行作为静脉血栓栓塞症的并发症而增加。 与2019年冠状病毒病患者40%的死亡有关(新冠肺炎)。这个 这项建议的总体目标是：1)完善和验证两个临床预测规则(CPR)用于评估 新冠肺炎在急诊科就诊或入院的患者中的静脉血栓栓塞率为2)至 设计、执行可用性测试，并在此基础上实现两个临床决策支持(CDS)工具 我们创新的、基于面向服务架构(SOA)的复杂CDS系统(CDSS)中的CPRS。 威尔斯的标准与D-Dimer相结合是一种CPR，帮助医疗保健提供者排除PE和 不必要的CT肺血管造影(CTPA)的必要性。此外，身患重病 住院患者在住院期间发生静脉血栓栓塞症的风险为中到高。 住院的新冠肺炎患者患静脉血栓栓塞症的风险特别高，最近的报告表明 内科病房DVT高达46%，ICU病房PE高达42%。这些数据与 与以前的病毒性肺炎(如H1N1)相关的VTE风险增加了23倍 为VTE服务。血栓预防对住院期间有显著益处，但必须适当使用 因为它有与出血相关的发病率和死亡率的风险。住院患者的静脉血栓形成风险很难确定 评估和医生依赖于CPR，如改善-D-二聚体(DD)用于患者护理。 我们的父母赠款(1R18HS026196-01A1)建议使用两个有效的CPR(Wells的标准和 改进的模型)在新的CDSS的上下文中，构建在将跨多个 电子健康记录(EHR)平台。我们将以我们最初的想法为基础，通过完善和验证 Wells‘s ED标准和住院新冠肺炎患者的改进-DD风险模型 通过利用我们目前正在为其开发的平台中提出的基础工作来实现CDS 家长拨款。这项工作意义重大，因为VTE评估的CPR是必要的，但尚未 在新冠肺炎患者中建立或验证。我们是唯一适合在Northwell Health执行这项工作的人 因为我们站在抗击大流行的第一线，已经治疗了超过150,000名新冠肺炎患者 对此队列进行高级大数据分析的后续性能，并为适当的 VTE风险评估的验证和后续实施。 该项目的长期目标是广泛实施基于证据的CDS工具 传播平台，有意义地告知新冠肺炎患者的全民VTE管理。

Project Abstract Venous thromboembolism (VTE), consisting of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a deadly disease with 30-day and one-year case fatality in the general population of 14% and 29%, respectively. This concern has increased with the recent pandemic as complications due to VTE have been associated with 40% of deaths of patients with Coronavirus Disease 2019 (COVID-19). The overarching aim of this proposal is: 1) to refine and validate two clinical prediction rules (CPRs) for assessment of VTE in patients presenting to or admitted from the emergency department (ED) with COVID-19 and 2) to design, perform usability testing, and implement two clinical decision support (CDS) tools based on these CPRs within our novel, innovative service-oriented architecture (SOA)-based complex CDS system (CDSS). Wells’ criteria in combination with D-Dimer is a CPR that helps healthcare providers exclude PE and the need for unnecessary computed tomography pulmonary angiography (CTPA). In addition, acutely-ill hospitalized medical patients are at moderate-to-high risk for developing VTE events during the hospital stay. Hospitalized COVID-19 patients are at especially high risk of VTE, with recent reports suggest a prevalence of DVT as high as 46% in medical wards and PE as high as 42% in ICU settings. These data are consistent with VTE risk associated with previous viral pneumonias such as H1N1 which have shown a 23-fold increased risk for VTE. Thrombo-prophylaxis shows significant benefits for in-hospital period, but must be used appropriately as it carries risk for morbidity and mortality related to bleeding. VTE risk in admitted patients is difficult to assess and physicians rely on CPRs such as IMPROVE-D-Dimer (DD) for patient care. Our parent grant (1R18HS026196-01A1) proposed the use of two validated CPRs (Wells’ criteria and the IMPROVE model) within the context of a novel CDSS, building on a SOA that will function across multiple electronic health record (EHR) platforms. We will build upon our original idea by refining and validating the Wells’ criteria in the ED and IMPROVE-DD risk model in hospitalized COVID-19 patients and then implementing the CDS by utilizing the groundwork set forth within the platform we are currently developing for the parent grant. This work is significant because CPRs for VTE assessment are essential but have not been established or validated in COVID-19 patients. We are uniquely suited to perform this work at Northwell Health as we are at the forefront of fighting the pandemic, having treated over 150,000 COVID-19 patients with subsequent performance of high-level big data analysis on this cohort and are well positioned for appropriate validation and subsequent implementation of VTE risk assessment. The long-term goal of this project is implementation of evidence-based CDS tools on a widely disseminated platform to meaningfully inform universal VTE management of COVID-19 patients.