Understanding and Improving Decision-making in Pneumonia with Informatics

利用信息学理解和改进肺炎决策

• 批准号: 10308553
• 负责人: Barbara Ellen Jones
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308553
• 关键词: Accident and Emergency department; Adopted; Ambulatory Care; Antibiotics; Area; Athletic; Back; Behavioral Sciences; Big Data; Biological Models; Caring; Cause of Death; Cessation of life; Clinical; Cognitive; Conscious; Consensus; Critical Care; Decision Making; Development; Diagnosis; Disease; Electronic Health Record; Environment; Etiology; Evidence Based Medicine; Feedback; Feeds; Foundations; Goals; Guidelines; Health Personnel; Health Services; Health Services Research; Healthcare; Healthcare Systems; Hospital Costs; Hospitals; Individual; Infection; Informatics; Interview; Judgment; Lead; Learning; Measures; Medicine; Methods; Microbiology; Modeling; Outcome; Patient-Focused Outcomes; Patients; Pattern; Philosophy; Physicians; Pneumonia; Population; Practice Guidelines; Provider; Recommendation; Research; Research Methodology; Research Personnel; Resources; Risk; Rural; Sampling; Source; System; Testing; Time; Triage; Uncertainty; United States; Variant; Veterans; Work; base; career; cognitive process; cost; design; evidence base; evidence based guidelines; experience; improved; improved outcome; individual patient; informatics tool; interest; learning progression; mortality; patient population; personalized care; personalized decision; pneumonia treatment; point of care; skills; success; support tools; theories

Introduction: This proposal aims to understand and improve the care of Veterans treated for pneumonia through informatics. Background: Pneumonia is the most common infectious cause of death in the United States, with an estimated 50,000 deaths and $8-10 billion in costs annually.12 Twenty-five thousand Veterans are seen per year in the Emergency Department, and 20,000 are hospitalized.13 Risk adjusted 30-day mortality rates range among VA facilities from 11% to 18%. The resources utilized for pneumonia also vary widely, with the cost of hospital care estimated at up to 25 times that of outpatient care.20 To improve the standard of pneumonia care, intense research and quality improvement efforts have been focused upon establishing evidence-based practice guidelines for pneumonia that represent a consensus of research and opinions generated from our best academic hospitals and pneumonia experts. However, we continue to see variation in both management and outcomes across the VA as in other systems, suggesting that guidelines may be difficult to apply to real practice. The recent advancement of our electronic health record allows us to measure actual practice at both the population and the individual level. By studying variation in triage and antibiotic decisions for patients with pneumonia, we can learn from our own population to generate evidence that includes the previously underrepresented patients, settings and scenarios, bringing it closer to real practice. Career Aims: My career goals are to: 1) Develop skills in advanced population analytics, 2) Gain a foundation in behavioral sciences, and 3) Develop a deeper understanding in informatics. Research Aims: My research aims build toward my career aims: (1) Examine sources of variation in triage and antibiotic selection decisions for pneumonia across VA emergency departments. (2) Characterize the cognitive processes influencing decision-making in pneumonia among providers at emergency departments demonstrating variation in decision-making. (3) Design and test an informatics tool that supports decision- making, integrates with workflow, and allows us to learn from clinical experience. Methods: Aim 1 A. will develop and test models of practice variation for triage and antibiotic selection and b. will identify emergency departments with high and low decision-making thresholds across the VA system. Aim 2 will use mixed methods to characterize the cognitive process of clinical reasoning and contextual influences impact decision-making through interviews with providers. Aim 3 will utilize a real-time informatics tool to test current best practice recommendations against physician decisions by providing physicians the opportunity to disagree with any recommendations, and collect information on reasons for disagreement. Impact: This work will directly inform the development of informatics tools for pneumonia for the VA. Ultimately, while my clinical interest is in pneumonia, the skills I develop will be applied to many clinical problems in medicine where decision-making occurs in the setting of uncertainty.

简介：该提案旨在了解和改善接受肺炎治疗的退伍军人的护理 通过信息学。 背景：肺炎是美国最常见的传染性死亡原因， 据估计，每年有 50,000 人死亡，造成 8-100 亿美元的损失。12 每场比赛有 25,000 名退伍军人参加。 急诊室每年有 20,000 人住院。13 风险调整后 30 天死亡率范围 VA 设施中的比例从 11% 增至 18%。用于肺炎的资源也有很大差异，其成本也不同。 医院护理估计高达门诊护理的 25 倍。20 为了提高肺炎护理标准， 深入的研究和质量改进工作的重点是建立基于证据的 肺炎实践指南代表了我们的研究和意见的共识 最好的学术医院和肺炎专家。然而，我们继续看到双方管理上的差异 以及与其他系统一样的 VA 的结果，这表明指导方针可能很难应用于实际情况 实践。我们的电子健康记录的最新进展使我们能够衡量两个方面的实际实践 人口和个人水平。通过研究患有以下疾病的患者的分诊和抗生素决策的变化 肺炎，我们可以从我们自己的人群中学习，以生成包括以前的证据 代表性不足的患者、环境和场景，使其更接近实际实践。 职业目标：我的职业目标是：1) 培养高级人口分析技能，2) 打下基础 行为科学，3) 加深对信息学的理解。 研究目标：我的研究目标是为了实现我的职业目标：(1) 检查分类中变异的来源 以及退伍军人管理局急诊科肺炎的抗生素选择决策。 (2) 表征 影响急诊科提供者肺炎决策的认知过程 展示决策的变化。 (3) 设计并测试支持决策的信息学工具 制作，与工作流程集成，使我们能够从临床经验中学习。 方法：目标 1 A. 将开发和测试用于分类和抗生素选择的实践变化模型，b. 将开发和测试用于分类和抗生素选择的实践变化模型。 将确定整个 VA 系统中决策门槛高低的急诊部门。目的 2.将使用混合方法来表征临床推理和情境影响的认知过程 通过与提供商的访谈影响决策。 Aim 3 将利用实时信息学工具来测试 通过为医生提供机会来反对医生决策的当前最佳实践建议 不同意任何建议，并收集有关不同意原因的信息。 影响：这项工作将直接为退伍军人管理局肺炎信息学工具的开发提供信息。 最终，虽然我的临床兴趣是肺炎，但我开发的技能将应用于许多临床 医学中的问题是在不确定的情况下做出决策。

项目成果

Capsule Commentary on Sanz et al., A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients.

Sanz 等人的胶囊评论，功能状态和肺炎严重程度指数的综合提高了老年患者肺炎死亡率的预测。

• DOI: 10.1007/s11606-017-4293-6
• 发表时间: 2018
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Jones,Barbara

Pneumonia and Electronic Health Records-A Window Into Disease, A Mirror of Our Behavior, or Just Another Streetlight?

肺炎和电子健康记录——了解疾病的窗口、我们行为的镜子，还是只是另一盏路灯？

• DOI: 10.1093/cid/ciz1053
• 发表时间: 2020
• 期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
• 作者: Jones,BarbaraEllen;Jones,MakotoMurakami
• 通讯作者: Jones,MakotoMurakami

Advances in community-acquired pneumonia.

• DOI: 10.1177/2049936120969607
• 发表时间: 2020-01
• 期刊: Therapeutic advances in infectious disease
• 影响因子: 5.7
• 作者: Jones B;Waterer G
• 通讯作者: Waterer G

Implementation of Real-Time Electronic Clinical Decision Support for Emergency Department Patients with Pneumonia Across a Healthcare System.

在整个医疗系统中为急诊室肺炎患者实施实时电子临床决策支持。

• 发表时间: 2019
• 期刊: AMIA ... Annual Symposium proceedings. AMIA Symposium
• 作者: Dean,NathanC;Vines,CarolineG;Rubin,Jenna;Collingridge,DaveS;Mankivsky,Mark;Srivastava,Raj;Jones,BarbaraE;Kuttler,KathrynG;Walker,Missy;Jenson,Nathan;Webb,BrandonJ;Allen,ToddL;Haug,PeterJ
• 通讯作者: Haug,PeterJ