Using Information Systems to Improve Cardiac Prevention

描述（由申请人提供）： 冠状动脉疾病（CAD）是美国的主要死亡原因，并且用于预防CAD的指南是良好建立的并且被证明是有益的。 然而，这些指南和实际的临床实践之间仍然存在很大的差距。 Schnipper博士是哈佛医学院的讲师，他的长期目标是改善心脏病预防服务的提供。 Schnipper博士的大部分研究时间都花在了普通内科上，研究导致心脏预防护理不佳的患者、医生和系统因素。 他加入了布里格姆妇女医院全科医学系，因为他们在开发和测试信息系统以提高临床护理质量方面有经验，并与他的导师大卫贝茨博士合作。 该研究项目有四个具体目标： 1)开发一种集成到电子病历（EMR）中的决策支持工具，旨在改善冠状动脉疾病的一级和二级预防。 2)开发基于电子病历的病例管理系统，提高CAD的二级预防水平。 3)确定基于电子病历的临床决策支持和病例管理在实施心脏预防服务方面的有效性和成本效益。 4)识别并解决患者、临床医生和系统障碍，以在各种门诊实践环境中有效使用基于计算机的质量改进策略。 该项目的早期阶段将包括医生焦点小组、问卷调查以及这些干预措施的迭代开发和测试。 随后，一系列的三个对照试验，随机的实践网站，将比较常规护理决策支持和决策支持加病例管理。 博士Schnipper将在这一奋进中得到一个由具有各种专业知识的高级教师组成的咨询委员会的帮助。 这项研究将导致更好的方法来实施心脏预防。 通过进行这项研究获得的经验，加上额外的课程工作和指导信息学，过程改进和试验设计，将确保Schnipper博士作为一个独立的研究人员在提高CAD患者的护理质量的发展。

DESCRIPTION (provided by applicant): Coronary artery disease (CAD) is the leading cause of death in the United States, and guidelines for the prevention of CAD are well established and of proven benefit. Nevertheless, there remains a wide gap between these guidelines and actual clinical practice. The long-term objective of Dr. Schnipper, an Instructor at Harvard Medical School, is to improve the provision of cardiac preventive services. Dr. Schnipper spent most of his fellowship in general internal medicine studying the patient, physician, and system factors that lead to sub-optimal cardiac preventive care. He joined the faculty of the General Medicine Division at Brigham and Women's Hospital because of their experience developing and testing information systems to improve quality of clinical care and to work with his mentor, Dr. David Bates. This research project has four specific aims: 1) To develop a decision support tool, integrated into an electronic medical record (EMR), designed to improve the primary and secondary prevention of coronary artery disease. 2) To develop an EMR-based case management system to improve the secondary prevention of CAD. 3) To determine the effectiveness and cost-effectiveness of EMR-based clinical decision support and case management on the implementation of cardiac preventive services. 4) To identify and address patient, clinician, and system barriers to the effective use of computer-based quality improvement strategies in a variety of outpatient practice settings. The early phases of this project will consist of physician focus groups, questionnaires, and iterative development and testing of these interventions. Later, a series of three controlled trials, randomized by practice site, will compare usual care to decision support and decision support plus case management. Dr. Schnipper will be aided in this endeavor by an advisory committee of senior faculty with varied expertise. This research will lead to better ways to implement cardiac prevention. The experience gained by conducting this research, coupled with additional course work and mentoring in informatics, process improvement, and trial design, will ensure Dr. Schnipper's development as an independent researcher in improving the quality of care of patients with CAD.