AUTOMATED CARDIAC DECISION SUPPORT SYSTEM IMPROVES CARE

描述(申请人提供)：心血管疾病仍然是美国死亡和发病的主要原因。为了帮助医疗从业者将新信息整合到临床实践中，美国国家胆固醇教育计划专家治疗小组(ATPIII)、美国心脏协会(AHA)、美国心脏病学会(ACC)和专家治疗小组(ATPIII)、国家高血压预防、检测、评估和治疗联合委员会(JNC VI)等专业组织制定了指南，以促进心血管疾病管理中的循证护理标准。尽管这些指导方针具有全面性并得到广泛传播，但目标参数并未实现，患者的管理也没有达到最佳状态。这些疾病包括血脂和血压目标的实现，冠心病和心房颤动患者使用抗血小板或抗凝治疗，心肌梗死后患者使用β-受体阻滞剂，以及收缩功能不全患者使用β-受体阻滞剂和转换酶抑制剂。为了促进将这些治疗指南纳入日常医疗实践，开发了心脏目标计划软件，以便根据已建立的指南，根据I级或A级建议，将对心血管疾病管理至关重要的数据输入到带有提醒系统的标准化、计算机化的形式中。我们的第一阶段计划侧重于将两家医院的计算机化实验室信息系统与我们的心脏目标计划连接起来，从而使数据录入过程的很大一部分“自动化”，并显著减少数据录入所需的时间和精力。这一第二阶段提案的目的是在一项多地点临床试验中评估修订后的软件，以评估该软件是否改善了从心力衰竭到冠状动脉疾病再到心房颤动的整个心血管系统的护理质量。我们还将采用可用性方法，包括与医生、护士和医生助理进行深入访谈和焦点小组，并根据从业者的反馈改进现有软件，并重新测试可行性。如果这种自动化的临床信息和决策支持系统成功并广泛实施，慢性心血管疾病的护理可能会取得最佳结果。

DESCRIPTION (provided by applicant): Cardiovascular disease continues to be the leading cause of mortality and morbidity in the United States. To assist health care practitioners in their integration of new information into clinical practice, professional organizations such as the National Cholesterol Education Program Expert Treatment Panel (ATP III), American Heart Association (AHA), American College of Cardiology (ACC), and Expert Treatment Panel (ATP III), Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), develop guidelines to promote evidence-based standards of care in the management of Cardiovascular disease. Despite the comprehensive nature and widespread dissemination of these guidelines, target parameters are not being achieved, and patients are not managed optimally. These diseases include achievement of lipid and blood pressure goals, usage of antiplatelet or anticoagulant therapy in patients with coronary artery disease and atrial fibrillation, usage of beta-blockers in patients post myocardial infarction, and the usage of beta-blockers and converting enzyme inhibitors in patients with systolic left ventricular dysfunction. To facilitate the incorporation of these treatment guidelines in everyday medical practice, the Cardiac Goal Program software has been developed to prompt entry of data essential to the management of cardiovascular disease, based on Class I or Grade A recommendations using established guidelines, into standardized, computerized forms with a reminder system. Our Phase I proposal focuses on the linking of two hospitals' computerized laboratory information system to our Cardiac Goal Program, thereby "automating" a substantial part of the data entry process and significantly reducing the time and effort required for data entry. The aims of this Phase II proposal are to evaluate the revised software in a multi-site clinical trial to assess whether the software improves the quality of care across the cardiovascular continuum, from heart failure to coronary artery disease to atrial fibrillation. We will also employ usability methodologies, including in-depth interviews and focus groups with physicians, nurses, and physicians' assistants, and refine the existing software based on the feedback from the practitioners and retest the feasibility. If this automated clinical information and decision support system is successful and widely implemented, the best outcomes from care for chronic cardiovascular disease may be achieved.