Engaging patients to enable interoperable lung cancer decision support at scale

项目摘要 肺癌是美国癌症相关死亡的主要原因，2020年死亡人数超过135，000人。一 一种被称为低剂量计算机断层扫描（LDCT）的筛查测试可以早期发现肺癌， 有严重吸烟史的人中的癌症死亡率，但这项测试需要患者和他们的 医生考虑潜在的好处和危害，根据每个病人的个人风险状况不同。 部分由于在忙碌的临床试验中计算和考虑这种患者特异性风险概况的复杂性， 在这种情况下，每年只有不到5%的合格患者接受筛查。为了满足这一迫切需要，我们 开发了一种名为Decision Precision+的工具，用于分析患者的电子健康记录（EHR）， 促使医生考虑为符合条件的患者进行肺癌筛查，并为医生提供个人- 关于肺癌筛查的潜在益处和危害的定制信息。在此过程中，决定 Precision+帮助患者及其医生在这方面做出明智的、以患者为中心的决定 可能拯救生命的测试自2020年以来，Decision Precision+已在犹他州健康大学投入临床使用， 符合条件的患者中肺癌筛查率大幅提高。为了帮助别人 卫生系统提高了适当的肺癌筛查率，决策精度+正在制定 作为免费工具提供给其他组织，可以下载并用于自己的EHR系统。 该项目将以三种方式建立在这一有前途的工作基础上。首先，我们将构建一个版本的工具， 与患者门户整合，患者可直接使用。我们称之为以病人为中心的工具 我的肺健康。医生和卫生系统将能够为符合条件的患者“开处方”MyLungHealth， 他们可以确保EHR中的吸烟档案是准确的， 对他们来说是正确的，因为他们在舒适的家中。其次，我们将把MyLungHealth引入初级保健 在犹他州和纽约大学的实践中， MyLungHealth在已经可以访问Decision Precision+的临床环境中提供。最后我们将 研究如何最好地帮助其他卫生系统实施这些工具，我们将开发自助服务资源 帮助实施。通过这些方式，我们将努力确保尽可能多的患者 可以受益于适当的肺癌筛查和相关的肺癌死亡率降低。

PROJECT SUMMARY Lung cancer is the leading cause of cancer-related deaths in the US, with over 135,000 deaths in 2020. A screening test known as low-dose computed tomography (LDCT) can detect lung cancer early and reduce lung cancer deaths among individuals with a history of heavy smoking, but this test requires patients and their doctors to consider potential benefits and harms that differ according to each patient’s individual risk profile. Due in part to the complexity of calculating and considering such patient-specific risk profiles in busy clinical settings, less than 5% of eligible patients receive the screening every year. To address this urgent need, we have developed a tool known as Decision Precision+ that analyzes patients’ electronic health records (EHRs), prompts doctors to consider lung cancer screening for eligible patients, and provides doctors with individually- tailored information on the potential benefits and harms of lung cancer screening. In doing so, Decision Precision+ helps patients and their doctors make informed, patient-centered decisions regarding this potentially life-saving test. Decision Precision+ has been in clinical use at University of Utah Health since 2020, and the rate of lung cancer screening among eligible patients has increased dramatically. So as to help other health systems increase their rates of appropriate lung cancer screening, Decision Precision+ is being made available to other organizations as a free tool that can be downloaded and used with their own EHR systems. This project will build upon this promising work in three ways. First, we will build a version of the tool that integrates with the patient portal and can be used directly by patients. We will call this patient-centered tool MyLungHealth. Doctors and health systems will be able to “prescribe” MyLungHealth to eligible patients, so that they can make sure their smoking profile in the EHR is accurate and can learn about whether lung cancer is right for them from the comfort of their own homes. Second, we will introduce MyLungHealth to primary care practices at the University of Utah and New York University and rigorously study how much added benefit MyLungHealth provides in clinical settings that already have access to Decision Precision+. Finally, we will study how best to help other health systems implement these tools, and we will develop self-service resources to help with implementation. In these ways, we will seek to help make sure that as many patients as possible can benefit from appropriate lung cancer screening and the associated reduction in lung cancer deaths.