COMPUTER BASED GUIDELINES TO PREVENT SUDDEN CARDIAC DEAT

基于计算机的预防心源性猝死指南

• 批准号: 6942509
• 负责人: GILLIAN D SANDERS SCHMIDLER
• 金额: $ 13.1万
• 依托单位: DUKE 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 2005-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6942509
• 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 In addition, traditional guidelines are normally static and thus may become out of date as new information emerges.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.

指南为改善患者管理提供了系统的方法。 它们的使用可以提高卫生保健的质量、适当性和有效性，还可以控制成本。然而，最佳的指南制定将包括临床医学、荟萃分析、决策分析、成本效益分析和证据综合方面的专家的投入;在地方一级，这些专家往往是不可用的，或者费用过高。 因此，国家组织往往为具有“平均”特征的人口制定准则。 这些指南可能需要适应当地的环境，其中患者人群或实践的特征是不同的。 此外，传统的准则通常是静态的，因此随着新信息的出现可能会过时。 为了解决这些问题，我们建议开发人员从决策模型中创建指南。 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，并随着基础决策模型或证据的演变而随时间修改指南。为了实现这一目标，我们提出的研究有三个具体目标：（1）使用基于网络的系统ALCHEMIST，根据循证决策模型开发自动创建指南的方法，（2）根据心律失常PORT（一项为期6年的预防心脏性猝死方法的多机构研究）的结果创建和评估指南，以及（3）评估，在一项随机对照试验中，临床医生使用我们开发的基于网络的指南系统与传统指南进行比较，并在一组假设的临床情况下提出治疗建议。如果我们成功地完成了我们的具体目标，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系统创建基于证据的可定制指南，用于根据心律失常PORT的发现预防心脏性猝死，（3）评价ALCHEMIST生成指南的益处和质量，（4）为ALCHEMIST指南系统临床实施的随机试验奠定了基础。 这些成就将有助于进一步AHRQ和NLM的使命，通过引导一种正式的方法来结合证据创建指南，并促进这些指南的传播和转化为临床实践。