Clinical Decision Support Tool to Assess Risk and Prevent Agitation Events

用于评估风险和预防躁动事件的临床决策支持工具

• 批准号: 10365272
• 负责人: Ambrose H Wong
• 金额: $ 19.38万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365272
• 关键词: Accident and Emergency department; Address; Aggressive behavior; Agitation; Award; Behavioral; Biometry; Characteristics; Clinical; Clinical Decision Support Systems; Clinical Trials; Collection; Complex; Data; Dissemination and Implementation; Early Diagnosis; Early treatment; Education; Electronic Health Record; Emergency Department Physician; Emergency Medicine; Emergency department visit; Enrollment; Ensure; Environment; Environmental Risk Factor; Equilibrium; Event; Face; Foundations; Goals; Harm Reduction; Health Services Research; Health system; Institution; Intervention; Interview; Knowledge; Laboratories; Lead; Medical; Mental Health; Mental Health Services; Mental disorders; Mentors; Methods; Modeling; Modification; National Institute of Mental Health; Outcome; Patient risk; Patient-Focused Outcomes; Patients; Physical Restraint; Policies; Predictive Factor; Prevention; Process; Provider; Public Health Informatics; Qualitative Methods; Randomized; Recommendation; Recording of previous events; Research; Research Activity; Resources; Risk; Risk Assessment; Risk Factors; Safety; Self Efficacy; Sudden Death; Symptoms; System; Techniques; Technology; Testing; Time; Training; Traumatic injury; Validation; Variant; Violence; Visit; Work; acute care; base; care delivery; career; clinical center; clinical decision support; clinical decision-making; clinical development; clinical research site; clinical trial implementation; cohort; comorbidity; emergency settings; feasibility testing; health record; improved; patient safety; pilot trial; predictive modeling; preemptive intervention; prevent; rapid diagnosis; restraint; risk prediction model; risk stratification; sedative; severe mental illness; skills; support tools; tool; usability; user centered design

PROJECT SUMMARY/ABSTRACT This award is a four-year plan to support Ambrose Wong, MD, MSEd, an emergency physician, in his transition towards an independent research career that focuses on dissemination and implementation of services for mental health crises in general, non-psychiatric emergency settings. The long-term goal of his research is to improve safety related to symptoms of agitation. To date, Dr. Wong's training has focused on emergency medicine, qualitative methods, and education-based interventions. Under a team of co-mentors with expertise in biostatistics, psychiatric services research, health informatics, and clinical trial implementation, Dr. Wong will build on his preliminary work on agitation prevention and management to accomplish the following training goals: (1) acquire expertise in clinical prediction modeling, (2) gain foundational knowledge in preventing, treating, and investigating mental health crises, (3) study health informatics and development of clinical support tools, and (4) obtain fundamental skills in clinical trials. The application integrates formal coursework and training through mentored research activities. Behavioral conditions in acute care settings are rapidly rising in the U.S., with a 50% increase in number of general emergency department (ED) visits for mental health conditions over the past decade. Agitation, defined as excessive psychomotor activity leading to violent behavior, is often part of these patient encounters. Of the 1.7 million agitation episodes occurring annually in general EDs, 83% are associated with an underlying serious mental illness. Given the safety risks of agitation, clinicians commonly use physical restraint, which are associated with up to 37% risk of complications including traumatic injuries and even sudden death in patients. Thus, regulatory bodies and experts emphasize early risk assessment and use of behavioral techniques before agitation occurs. However, variability in practice and policy of these techniques exists in emergency settings. This is due to lack of knowledge regarding specific risk factors that predict the need for pre-emptive intervention and challenges in assessing these risk factors in the busy environment of an ED. The objective of this project is to develop and test the Early Detection and Treatment to Reduce Events with Agitation Tool (ED- TREAT), a clinical decision support system embedded in the electronic health record that will guide clinicians in early risk assessment and appropriate treatment of mental health patients likely to develop agitation. We will first derive a clinical model using health record data and preliminary analyses by our team that predicts which at-risk patients will develop agitation and require use of physical restraint. Next, we will develop and refine ED- TREAT through user-centered design techniques with clinicians and patients. Finally, we will conduct a pilot trial to test the feasibility, fidelity, and bedside acceptability of ED-TREAT. Aligned with NIMH's strategic priorities to use technology for improving mental health delivery in non-specialty settings, this study will form the basis for a subsequent full-scale clinical trial to examine ED-TREAT's effect on clinical outcomes.

项目摘要/摘要 该奖项是一项为期四年的计划，旨在支持马里兰州Ambrose Wong，MSED，一名紧急医生 向独立研究职业过渡，重点是传播和实施 一般非精神病学紧急情况的心理健康危机服务。他的长期目标 研究是为了改善与躁动症状有关的安全性。迄今为止，Wong博士的培训重点是 急诊医学，定性方法和基于教育的干预措施。在一个联合给出的团队的领导下 凭借生物统计学，精神科服务研究，健康信息学和临床试验实施方面的专业知识， Wong博士将以他在预防和管理方面的初步工作为基础 遵循培训目标：（1）获得临床预测建模方面的专业知识，（2）获得基础知识 预防，治疗和调查心理健康危机，（3）研究健康信息学和发展 临床支持工具，（4）获得临床试验的基本技能。该应用程序集成了正式 课程和培训通过指导的研究活动。 急性护理环境中的行为状况在美国迅速上升，数量增加了50％ 过去十年来，总急诊科（ED）访问了心理健康状况。搅动， 被定义为导致暴力行为的过度精神运动活动，通常是这些患者遇到的一部分。 在一般ED中每年发生的170万次搅动发作中，有83％与基础有关 严重的精神疾病。鉴于搅动的安全风险，临床医生通常使用身体约束，这是 与并发症的风险高达37％有关，包括创伤性损伤甚至患者猝死。 因此，监管机构和专家强调早期风险评估和行为技术的使用 发生搅动。但是，这些技术的实践和政策的可变性存在于紧急情况下。 这是由于缺乏有关预测预先避免需求的特定风险因素的知识 在ED的繁忙环境中评估这些危险因素时的干预和挑战。目的 该项目将开发和测试早期检测和治疗，以减少搅拌工具（ED-）减少事件 Treat），一种嵌入电子健康记录中的临床决策支持系统，该系统将指导临床医生 在早期风险评估和对心理健康患者的适当治疗中，可能会引起躁动。我们将 首先使用健康记录数据和我们团队的初步分析得出临床模型，以预测哪个 处于危险的患者将搅动并需要使用身体约束。接下来，我们将开发和完善 通过以用户为中心的设计技术与临床医生和患者进行治疗。最后，我们将进行飞行员 试验以测试ED-TREAT的可行性，保真度和床边可接受性。与NIMH的战略一致 使用技术来改善非专业环境中的心理健康提供的优先事项，这项研究将形成 随后进行全尺度临床试验的基础，以检查ED-治疗对临床结果的影响。