Building Learning Health System Capacity: Leveraging Lessons from an Evaluation of a SEPSIS Clinical Decision Support Tool

建设学习卫生系统能力：利用脓毒症临床决策支持工具评估的经验教训

• 批准号: 10432646
• 负责人: ALLYSON GAIL HALL
• 金额: $ 10万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10432646
• 关键词: Building; Learning; Health; System; Capacity

Project Summary Sepsis is a clinical syndrome defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. There is significant burden associated with sepsis, with over 1.7 million adult cases diagnosed annually in the U.S., which in turn contribute to 270,000 deaths. These clinical challenges are mirrored in the cost of treating sepsis, which ranks highest among all conditions in U.S. hospitals and represents 13% of all hospital costs while accounting for only 3.6% of all hospital stays. A fundamental challenge to diagnosing and treating sepsis, and thus reducing its cost and quality burden, is that there is no confirmatory diagnostic test. Rather the diagnosis of sepsis requires clinical judgment based on evidence of infection and organ dysfunction provided from multiple sources, including microbiology, medication administration, laboratory, and administrative/coding data. One approach to overcome these challenges is to use clinical decision support systems that provide clinical knowledge and patient-related information to providers at appropriate times to enhance patient care. Yet, the application of clinical decision support systems to sepsis care is in its infancy and challenges to implementation are not well understood. The purpose of this mixed methods study is to evaluate the implementation of a clinical decision support system to understand its effect on clinical and implementation outcomes. Importantly, the implementation of the clinical decision support system occurs in the context of a larger health system initiative to become a Learning Health System, defined as an organization that continuously evaluates and adapts practices using data and analytics to generate knowledge and implement behavior change that can improve quality. Thus, the study is guided by the following aims: Aim 1: Assess fidelity to a sepsis detection and treatment program and iteratively identify adaptations required to scale up the program; Aim 2: Examine the influence of a sepsis detection and treatment program on clinical and implementation outcomes; and Aim 3: Develop a process for integrating study findings and institutionalize Learning Health System program evaluation capacity.

项目摘要 脓毒症是一种临床综合征，定义为由宿主失调引起的危及生命的器官功能障碍 对感染的反应。脓毒症是一个重大的负担，超过170万的成人病例 每年在美国被诊断出，这又导致了27万人死亡这些临床挑战反映了 在治疗败血症的费用中，败血症在美国医院的所有疾病中排名最高，占美国医院总费用的13%。 所有住院费用，而只占所有住院时间的3.6%。一个根本的挑战，诊断和 治疗脓毒症并因此降低其成本和质量负担的最大障碍是没有确证性诊断测试。 脓毒症的诊断需要根据感染和器官功能障碍的证据进行临床判断 从多个来源提供，包括微生物学、药物管理、实验室和 管理/编码数据。克服这些挑战的一种方法是使用临床决策支持 在适当时间向提供者提供临床知识和患者相关信息的系统， 加强病人护理。然而，临床决策支持系统在脓毒症护理中的应用尚处于起步阶段， 执行方面的挑战尚未得到很好的理解。这项混合方法研究的目的是评估 临床决策支持系统的实施，以了解其对临床和实施的影响 结果。重要的是，临床决策支持系统的实施发生在一个 更大的卫生系统倡议，成为一个学习卫生系统，定义为一个组织， 使用数据和分析来评估和调整实践，以生成知识并实施行为改变 这可以提高质量。因此，该研究由以下目的指导：目的1：评估对脓毒症的保真度 检测和治疗方案，并反复确定扩大方案所需的适应性;目标2： 检查脓毒症检测和治疗计划对临床和实施结果的影响; 目标3：制定一个整合研究结果的过程，并使学习健康系统计划制度化 评价能力。