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

项目总结/摘要 小儿感染性休克是儿童死亡的主要原因，无病生存取决于 及时诊断和治疗。尽管医学界、公众和州立法机构已经 越来越多的人认识到，在诊断儿童感染性休克的延误是一个重要原因， 由于败血症的发病率是可预防的，因此没有有效的预测模型来改善儿童败血症的早期诊断。 候选人哈尔登·斯科特博士是科罗拉多儿童医院的儿科急诊医生， 科罗拉多大学医学院。她在一项研究中批判性地评估了早期诊断策略， 她设计的电子健康记录（EHR）衍生的儿科败血症登记处将支持 提议的研究。她正在寻求发展成为一个独立的卫生服务研究人员，通过 建议指导研究，目标如下：1）推导和测试模型，以预测脓毒性休克， 现有的EHR衍生数据集，比较两种现代建模技术衍生的模型; 2）创建一个 早期识别感染性休克的EHR决策支持工具; 3）进行 儿童医院内社区和学术儿科急诊护理环境中的决策支持 科罗拉多电视网。该实施和可行性数据将为未来的多中心实用试验提供信息， 计算机化的决策支持在儿科感染性休克的诊断，斯科特博士将提出在R01 在K奖结束前申请。斯科特博士的研究轨迹是促进和丰富了强大的 机构临床，信息学和行政支持，以及她在儿科急诊的参与 护理应用研究网络和国际脓毒症指南委员会。 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， 在学习卫生系统中使用卫生信息技术，并进行务实的试验。斯科特博士在全国 著名的导师将支持这些目标：肯普博士，专家在务实的试验，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在机器学习、临床儿科急诊方面提供专业知识 研究重症监护和败血症该提案响应了AHRQ的优先事项：提高医疗保健质量 通过信息系统，通过综合证据提高安全和质量，并侧重于AHRQ 优先人群，包括儿童和有长期护理需求的人。研究、指导和 提出的培训计划非常适合为斯科特博士提供发展成为一名 一个独立的卫生服务研究人员，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， 开展务实的试验，以检验在紧急情况下实施循证做法的情况。

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.