COMPUTER BASED GUDIELINES TO PREVENT SUDDEN CARDIAC DEAT

基于计算机的预防心脏猝死的指南

• 批准号: 6391145
• 负责人: GILLIAN D SANDERS SCHMIDLER
• 金额: $ 33.5万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6391145
• 关键词: Internet; arrhythmia; behavioral /social science research tag; cardiovascular disorder prevention; clinical research; computer assisted medical decision making; computer assisted patient care; computer system design /evaluation; health care service evaluation; health services research tag; human subject; patient care management; questionnaires; sudden cardiac death

Guidelines provide a systematic means to improve patient management. Their use can enhance the quality, appropriateness, and effectiveness of health care, and may also contain costs. Optimal development of guidelines, however, would include input from experts in clinical medicine, meta-analyses, decision analyses, cost-effectiveness analyses, and evidence synthesis; such experts often are not available, or are prohibitively costly, on a local level. Therefore, national organizations often develop guidelines for a population that has "average" characteristics. These guidelines may need to be adapted to local settings in which the characteristics of the patient population or practice are different. In addition, traditional guidelines are normally static and thus may become out of date as new information emerges. To address these problems, we propose that developers create guidelines from decision models. These guidelines contain the knowledge necessary to allow users to customize the guidelines to a local patient or population, and to modify the guidelines over time as the underlying decision model or evidence evolves. To achieve this goal, our proposed research has three specific aims: (1) to develop methods for the automated creation of guidelines from evidence-based decision models, using a web-based system called ALCHEMIST, (2) to create and evaluate guidelines based on the findings of the Cardiac Arrhythmia PORT, a 6-year multi-institutional study of methods to prevent sudden cardiac death, and (3) to evaluate, in a randomized controlled trial, clinicians' use of and their satisfaction with our developed web- based guideline system compared with traditional guidelines for making treatment recommendations on a set of hypothetical clinical scenarios. If we successfully complete our specific aims, we will have: (1) demonstrated that developers can use decision models to create guidelines automatically, (2) used the ALCHEMIST system to create an evidence-based customizable guideline for prevention of sudden cardiac death based on the findings of the Cardiac Arrhythmia PORT, (3) evaluated the benefits and quality of the ALCHEMIST- generated guidelines, and (4) laid the groundwork for a randomized trial of clinical implementation of the ALCHEMIST guideline system. These achievements will help further the missions of the AHRQ and the NLM by leading toward a formalized method for combining evidence to create guidelines, and facilitating dissemination and translation of these guidelines into clinical practice.

指南提供了改善患者管理的系统方法。 它们的使用可以提高医疗保健的质量、适当性和有效性，但也可能会降低成本。然而，指南的最佳制定将包括临床医学专家的意见、荟萃分析、决策分析、成本效益分析和证据综合；地方一级往往缺乏此类专家，或者费用高昂。 因此，国家组织经常为具有“平均”特征的人群制定指导方针。 这些指南可能需要适应当地患者群体或实践特征不同的环境。 此外，传统指南通常是静态的，因此随着新信息的出现可能会过时。 为了解决这些问题，我们建议开发人员根据决策模型创建指南。 这些指南包含必要的知识，允许用户针对当地患者或人群定制指南，并随着基本决策模型或证据的发展而随时修改指南。为了实现这一目标，我们提出的研究有三个具体目标：(1) 使用名为 ALCHEMIST 的网络系统开发基于证据的决策模型自动创建指南的方法，(2) 根据心律失常 PORT 的研究结果创建和评估指南，这是一项为期 6 年的多机构研究，旨在预防心源性猝死的方法，以及 (3) 在随机对照试验中评估临床医生的使用情况 与针对一组假设的临床场景提出治疗建议的传统指南相比，他们对我们开发的基于网络的指南系统的满意度以及满意度。如果我们成功完成我们的具体目标，我们将：(1) 证明开发人员可以使用决策模型自动创建指南，(2) 使用 ALCHEMIST 系统根据心律失常 PORT 的研究结果创建基于证据的可定制指南，用于预防心源性猝死，(3) 评估 ALCHEMIST 生成的指南的益处和质量，以及 (4) 为临床随机试验奠定基础 ALCHEMIST 指南系统的实施。 这些成就将有助于进一步实现 AHRQ 和 NLM 的使命，引导形成一种结合证据来制定指南的正式方法，并促进这些指南的传播和转化为临床实践。