Refinement and enhancement of a web-based risk calculator deployment system

描述（由申请人提供）：基于网络的风险计算器部署系统的改进和增强。医疗决策的质量受到影响，因为风险预测不是针对个体患者的。此外，现有的风险模型和工具没有得到广泛使用，因为它们不容易使用，没有用处，或者两者兼而有之。有能力从统计模型中提供床边预测，允许连续的风险估计将代表重大进展，并有可能对临床医生和患者如何做出治疗决策产生广泛而重大的影响。我们已经开始开发基于网络的基础设施，使统计人员能够快速生成在线风险计算器，以促进预测模型的应用。该提案的目标是增强和广泛扩展我们的风险计算器构造器，该构造器旨在提供针对个体患者的风险估计。没有其他通用的在线风险计算器可用。该基础设施旨在通过使非程序员非常容易地创建用户友好的风险计算器应用程序，快速加速风险方程到临床实践的转换。该工具对统计人员和最终用户免费（例如，临床医生），易于双方使用，并在任何网络浏览器（包括黑莓）上运行。虽然我们有一个测试版，但在它获得广泛接受之前，我们需要大大增强和扩展它。因此，我们的目标是：（1）扩展现有功能。创作和临床医生界面都将受益于额外的功能，包括支持更广泛的输入变量格式和更具表现力的有效性约束，包括额外的预定义的统计模型，扩展的文档和注释功能，提供“撤销”功能，以及更灵活的发布功能。这些增强功能中的大多数都涉及对现有编辑工具及其相应的计算器生成和评估组件的更改。2)开发新功能。我们将更改底层系统架构，以便能够在执行风险计算时对缺失值进行动态插补，并在结果矩阵中安排多个预测以生成比较有效性表等功能。3)修改底层基础设施并提高健壮性。需要进行一些小的调整来平滑系统性能，包括使用更系统的方法来测试一些新引入的功能和版本，以确保一致性，增加对更广泛平台的支持，以及更智能地使用可用的Web浏览器功能。我们希望开发该系统的监视能力，以捕获和分析有关计算器使用的统计数据，并倾向于观察到的问题。综上所述，这项技术具有很高的创新性，可以应用到很多医疗决策中，这是一个非常广泛的影响。它有可能从根本上影响几乎所有可以开发统计模型的医疗决策领域。 公共卫生相关性：当面临复杂的医疗决策时，如果预测结果适合个体患者，医生和患者可以做出更好的决策。没有成本效益高的方法可以允许这种精确的剪裁。我们正在开发一种易于使用的在线工具，可以根据患者的个体特征预测患者的结局。如果我们的工具被广泛采用，它有可能从根本上影响医疗决策，并对所有医生的行医方式产生广泛的影响。

DESCRIPTION (provided by applicant): Refinement and enhancement of a web-based risk calculator deployment system .The quality of medical decision making suffers because risk predictions are not tailored to the individual patient. Further, available risk models and tools are not widely used because they are not easy to use, not useful, or both. Having the ability to provide bedside predictions from statistical models that permit continuous risk estimation would represent major progress and has the potential for broad and significant impact on how clinicians and patients make treatment decisions. We have begun to develop a web-based infrastructure that allows statisticians to quickly produce an online risk calculator to facilitate application of prediction models. The goal of this proposal is to enhance and broadly expand our risk calculator constructor, which is designed to provide risk estimations tailored to the individual patient. No other generic online risk calculator is available. The infrastructure is designed to rapidly accelerate the translation of risk equations to clinical practice by making the process very easy for a nonprogrammer to create a user- friendly risk calculator application. The tool is free to both statistician and end-user (e.g., clinician), easy to use by both parties, and runs on any web browser (including the BlackBerry's). Although we have a working beta version, we need to enhance and expand it considerably before it will gain widespread acceptance. Therefore, we aim to 1) extend the existing functionality. Both the authoring and clinician interfaces would benefit from additional functionality, including support for a wider variety of input variable formats and more expressive validity constraints, inclusion of additional predefined statistical models, extended documentation and annotation capabilities, provision of an "undo" feature, and more flexible publishing capabilities. Most of these enhancements involve changes to the existing editing tool and their corresponding calculator generation and evaluation components. 2) develop new functionality. We will change the underlying system architecture so it will be capable of on-the-fly imputation of missing values present when performing risk calculations, as well as arranging multiple predictions in a matrix of results to generate comparative effectiveness tables, among other functions. 3) revise the underlying infrastructure and improve robustness. Minor tweaks are needed to smooth system performance, including testing some newly introduced features and revisions using a more systematic methodology to assure consistency, adding support for a wider variety of platforms, and more intelligent use of available web-browser capabilities. We would like to develop the system's surveillance capabilities to capture and analyze pertinent statistics on calculator use and tend to observed problems. In summary, this technology is highly innovative and can be applied to many medical decisions, which is a very broad impact. It has the potential to radically affect almost any area of medical decision making where statistical models can be developed. PUBLIC HEALTH RELEVANCE: When faced with complex medical decisions, physicians and patients could make much better decisions if predicted outcomes were tailored to the individual patient. No cost-effective method is available that permits this precise tailoring. We are developing an easy-to-use online tool that allows patient outcome to be predicted based on the patient's individual characteristics. If our tool is widely adopted, it has the potential to radically affect medical decision making and to have a broad impact on how all physicians practice medicine.