Enhancing Quality in Pediatrics Sepsis with Shock Prediction and Early Electronic Decision Support (EQUIP with SPEED)

项目摘要/摘要 儿童感染性休克是儿童死亡的主要原因，无病生存取决于 关于及时诊断和治疗。尽管医学界、普通公众和州立法机构 越来越多的人认识到，儿童感染性休克的诊断延误是导致 在可预防的发病率方面，目前还没有经过验证的预测模型来改善儿童脓毒症的早期诊断。 候选人哈尔登·斯科特博士是科罗拉多州儿童医院的儿科急诊医生， 科罗拉多大学医学院。她对早期诊断策略进行了批判性的评估 电子健康记录(EHR)派生的儿科败血症登记处，她设计的，将支持 拟开展的研究。她正在寻求发展成为一名独立的卫生服务研究员，通过 提出了以下目标的指导性研究：1)推导和测试预测感染性休克的模型 现有的EHR派生的数据集，比较使用两种现代建模技术派生的模型；2)创建 EHR决策支持工具，用于感染性休克的早期识别；3)进行试点实施试验 儿童医院内社区和学术儿科急救环境中的决策支持 科罗拉多电视网。这一实施和可行性数据将为未来的多中心务实试验提供参考 斯科特博士将在R01中提出的在儿童感染性休克诊断中的计算机决策支持 在K奖结束前申请。斯科特博士的研究轨迹得到了强大的推动和丰富 机构临床、信息学和行政支持，以及她在儿科急救中的参与 CARE应用研究网络和国际败血症指南委员会。 该奖项将支持斯科特博士的职业发展目标：获得预测建模技能， 利用卫生信息技术学习卫生系统，并进行务实试验。斯科特博士在全国范围内 知名导师将支持这些目标：肯佩博士，务实试验、计划评估和 实施研究；Fairclough博士，统计和建模专家；Kahn博士，研究和 临床信息学。其他顾问贡献了机器学习、临床儿科急救方面的专业知识 研究、重症监护和败血症。这项提案回应了AHRQ的优先事项：提高医疗质量 通过信息系统，通过综合证据提高安全和质量，并重点关注AHRQ 优先人群，包括儿童和有长期护理需要的人。研究、指导和 建议的培训计划非常适合为Scott博士提供发展为 独立卫生服务研究人员专注于提高儿科急诊护理质量 通过在学习卫生系统中使用卫生信息技术，改善卫生状况，特别是败血症； 进行务实试验，以测试在紧急情况下循证实践的实施情况。

PROJECT SUMMARY / ABSTRACT Pediatric septic shock is a leading cause of childhood death, in which morbidity-free survival depends on timely diagnosis and treatment. Although the medical community, general public and state legislatures have increasingly recognized that delays in diagnosing septic shock in children are an important cause of preventable morbidity, there are no validated predictive models to improve early sepsis diagnosis in children. The candidate, Dr. Halden Scott, is a pediatric emergency physician at Children's Hospital Colorado and the University of Colorado School of Medicine. She has critically evaluated early diagnostic strategies in an Electronic Health Record (EHR)-derived pediatric sepsis registry that she designed that will support the proposed research. She is seeking to develop into an independent health services researcher, through the proposed mentored research with the following goals: 1) Derive and test models to predict septic shock in an existing EHR-derived dataset, comparing models derived with two modern modeling techniques; 2) create an EHR decision support tool for the early recognition of septic shock; 3) conduct a pilot implementation trial of decision support in community and academic pediatric emergency care settings within the Children's Hospital Colorado network. This implementation and feasibility data will inform a future multicenter pragmatic trial of computerized decision support in diagnosis of pediatric septic shock, which Dr. Scott will propose in an R01 application before the end of the K award. Dr. Scott's research trajectory is facilitated and enriched by strong institutional clinical, informatics and administrative support, and her involvement in the Pediatric Emergency Care Applied Research Network and international sepsis guidelines committees. This award would support Dr. Scott's career development goals: acquire skills in predictive modeling, the use of health information technology in learning health systems, and pragmatic trials. Dr. Scott's nationally renowned mentors will support these goals: Dr. Kempe, expert in pragmatic trials, program evaluation and implementation research; Dr. Fairclough, expert in statistics and modeling; Dr. Kahn, expert in research and clinical informatics. Additional advisors contribute expertise in machine learning, clinical pediatric emergency research, critical care and sepsis. This proposal responds to AHRQ priorities: improving health care quality through information systems, improving safety and quality by synthesizing evidence, and focuses on AHRQ priority populations including children and those with chronic care needs. The research, mentorship and training plan proposed are ideally suited to provide Dr. Scott with the skills needed to develop into an independent health services researcher focused on improving the quality of care for pediatric emergency conditions, particularly sepsis, through the use of health information technology in learning health systems, and conduct of pragmatic trials to test implementation of evidence-based practice in emergency settings.