STEPPED-CARE COLLEAGUE: AUTOMATED THERAPY REVIEW IN HYP

临床决策支持系统和医疗信息系统都是 对医学信息学非常感兴趣。理想情况下，这两种类型的 系统应紧密相连，以提供最大程度的教育和 临床应用。通常，医学信息学的发展强调一个 排除其他系统的系统类型。的主要目标是 这项提议是开发一个通用的、相互关联的系统，在其中，医疗 决策支持模块中表示的知识被应用于 在现有信息系统的背景下的临床环境。这个 主要优势是实用的：决策支持所需的数据 系统已经可用；没有特殊的数据收集或录入 需要的。决策支持系统提供的建议载于 临床“实时”优化其效果。第二个目标是 最大限度地利用非人工智能医学(AIM)系统 当表示医学知识和决策过程时 恰如其分。这是具有成本效益的，如果足够强大，可能会 适用于多种类型的医疗决策问题。 在这个提案中，我们计划开发通用方法，并将它们应用于 单一临床环境：高血压护理。具体工作将检验 假设自动化治疗管理审查系统可能 使用与系统相结合的非AIM基于规则的结构创建 旨在经常收集相关的临床信息，以提供 对医疗服务提供者目前的医疗管理进行了复杂的分析。这个 系统将调查当前的临床数据，并在分阶段护理之后 治疗高血压的方法，建议提供者何时 应适当增加治疗、修改治疗或减少治疗 情况。 原型系统将在全科医学实践中进行研究。 测试将包括检查其在以下方面的表现 信度和效度及其对提供者和他们的心理影响 收益和满意度的感知及其成本和对STEP的影响 护理疗法。如果这个开发和可行性项目成功， 我们将考虑提交一份提案，将已开发的系统 更明确的研究。

Clinical decision support systems and medical information systems are both of great interest in medical informatics. Ideally these two types of systems should be closely linked to provide maximum educational and clinical utility. Usually medical informatics development emphasizes one type of system to the exclusion of the other. The primary objective of this proposal is to develop a generic, linked system in which medical knowledge represented in the decision support module is applied in the clinical setting in the context of an existing information system. The major advantages are practical: the data required by the decision support system is already available; no special data collection or entry is needed. The advice given by the decision support system is presented in clinical "real-time" to optimize its effect. The second objective is to maximally exploit non-artificial intelligence in medicine (AIM) systems for representing medical knowledge and decision making processes when appropriate. This is cost effective and, if sufficiently robust, may be adequate for many types of medical decision problems. In this proposal we plan to develop general methods and apply them to a single clinical setting: hypertension care. The specific work will test the hypothesis that an automated therapeutic management review system may be created, using a non-AIM rule-based structure coupled with a system designed to frequently gather pertinent clinical information, to provide sophisticated analysis of current medical management for providers. The system will survey current clinical data and, following a stepped care approach to the treatment of hypertension, advise providers as to when they should increase therapy, modify therapy, or reduce therapy in appropriate circumstances. The prototype system will be studied in a general medicine practice. Testing will involve the examination of its performance in terms of reliability and validity, its psychological impact on providers and their perception of benefit and satisfaction, and its cost and impact on stepped care therapy. If this development and feasibility project is successful, we will consider submitting a proposal to subject the developed system to more definitive study.