Evaluation of Computerized Decision Support for Managing Lung Nodules

肺结节管理计算机决策支持的评估

• 批准号: 8073972
• 负责人: Michael K Gould
• 金额: $ 9.98万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-27 至 2011-08-12
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073972
• 关键词: Adherence; Algorithms; Benign; Biopsy; Caliber; Cancerous; Chest; Clinical; Clinical Management; Clinical Medicine; Computer Architectures; Computers; Decision Making; Decision Modeling; Decision Support Systems; Diagnosis; Diagnostic; Effectiveness; Evaluation; Excision; Exposure to; Feedback; Frequencies; Funding; Future; Goals; Grant; Health; Healthcare; Intervention; Knowledge; Laboratories; Lead; Link; Lung; Lung nodule; Malignant - descriptor; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Methods; Modeling; Nodule; Online Systems; Operative Surgical Procedures; Outcome; Patient Care; Patient Preferences; Patient observation; Patients; Peer Review; Performance; Physicians; Population; Primary Health Care; Probability; Process; Pulmonary Coin Lesion; Qualitative Methods; Randomized Controlled Trials; Recommendation; Research; Risk; Site; Smoker; Solitary Nodule; Spottings; Surgical complication; System; Testing; Thoracic Oncology; Thoracic Surgeon; Time; Unnecessary Surgery; Validation; base; clinical practice; computerized; cooperative study; cost; cost effectiveness; design; improved; innovation; medical specialties; member; novel; programs; randomized trial; tool; trial comparing; usability

DESCRIPTION (provided by applicant): In previous research, members of our group developed ALCHEMIST, a computerized decision support system that generates patient- and site-specific recommendations for patient management based on decision- analytic models. Subsequently, we developed ALCHEMIST-SPN, a web-based decision support system for managing patients with solitary pulmonary nodules (SPN), by linking a rigorously developed decision analytic model with the existing ALCHEMIST architecture for computer-based decision support. Concurrently, we performed a statistical validation of the decision model, and showed that decision support with ALCHEMIST-SPN has the potential to improve quality-adjusted survival, reduce cost, and reduce the frequency of unnecessary surgery in patients with benign nodules and inappropriate "watchful waiting" in patients with malignant nodules. Management of lung nodules is a very attractive target for computer-based decision support; it is a common problem, multiple possible management strategies exist, and the optimal management approach depends on pre-test probability, the risk of surgical complications, patient preferences, and other factors. In this second revision of our competing renewal application, we seek funding to continue our systematic evaluation of ALCHEMIST-SPN. Specifically, we have revised our aims and methods based on helpful feedback from reviewers of our previous applications. The revised proposal includes three specific aims: (1) to conduct a rigorous process of usability testing and peer review, to enable design and refinement of a decision support system that is highly responsive to the needs of potential users; (2) to determine whether ALCHEMIST-SPN has the potential to improve outcomes in patients with lung nodules under idealized laboratory conditions, by conducting a randomized, controlled trial that compares management of clinical vignettes by physicians following exposure to either ALCHEMIST-SPN or a static flow-chart algorithm; (3) to implement ALCHEMIST-SPN in two health care settings, by integrating the decision support system into the clinical workflow of SPN management, and to conduct a "before and after" implementation study of ALCHEMIST-SPN in these settings to determine whether clinicians will use the decision support system and adhere to its recommendations. By accomplishing these aims, we will not only evaluate the performance of a highly innovative computerized decision support system for managing lung nodules, but also improve the system's performance based on feedback from both experts and practicing clinicians in laboratory and clinical settings. Ultimately, we believe that our approach to computerized decision support with ALCHEMIST-SPN has the potential to improve management in patients with lung nodules, and may be broadly applicable to other challenging problems in thoracic oncology and clinical medicine. PUBLIC HEALTH RELEVANCE This research aims to evaluate a novel, computer-based system for improving management in patients with solitary pulmonary nodules (or "spots on the lung"), which sometimes represent a curable form of lung cancer. By evaluating and eventually implementing the system, we aim to reduce the frequency of unnecessary surgery in patients with non-cancerous lung nodules, and reduce the number of delayed surgeries that may lead to missed opportunities for cure in patients with cancerous nodules.

描述（由申请人提供）：在以前的研究中，我们小组的成员开发了ALCHEMIST，这是一种计算机化的决策支持系统，可以根据决策分析模型为患者管理生成患者和研究中心特定的建议。随后，我们开发了ALCHEMIST-SPN，一个基于网络的决策支持系统，用于管理孤立性肺结节（SPN）患者，通过将严格开发的决策分析模型与现有的ALCHEMIST架构相连接，以实现基于计算机的决策支持。同时，我们对决策模型进行了统计学验证，结果表明，ALCHEMIST-SPN决策支持有可能提高质量调整生存率，降低成本，减少良性结节患者不必要的手术频率和恶性结节患者不适当的“观察等待”。肺结节的管理是基于计算机的决策支持的一个非常有吸引力的目标;这是一个常见的问题，存在多种可能的管理策略，最佳管理方法取决于预测试概率，手术并发症的风险，患者偏好和其他因素。在我们的竞争性更新申请的第二次修订中，我们寻求资金来继续我们对ALCHEMIST-SPN的系统评估。具体来说，我们已经修改了我们的目标和方法的基础上，从我们以前的应用程序的审查员有益的反馈。修订后的提案包括三个具体目标：（1）进行严格的可用性测试和同行审查，以便能够设计和改进一个对潜在用户的需求作出高度反应的决策支持系统;（2）在理想的实验室条件下，通过进行随机化，对照试验，比较暴露于ALCHEMIST-SPN或静态流程图算法后医生对临床小插曲的管理;（3）在两个卫生保健机构实施ALCHEMIST-SPN，将决策支持系统纳入SPN管理的临床工作流程，并在这些环境中进行ALCHEMIST-SPN实施“前后”研究，以确定临床医生是否会使用决策支持系统并遵守其建议。通过实现这些目标，我们不仅将评估一个高度创新的计算机化决策支持系统管理肺结节的性能，而且还将根据专家和实践临床医生在实验室和临床环境中的反馈，提高系统的性能。最终，我们相信，我们的方法与ALCHEMIST-SPN的计算机化决策支持有可能改善肺结节患者的管理，并可能广泛适用于其他具有挑战性的问题，在胸部肿瘤学和临床医学。公共卫生相关性本研究旨在评估一种新型的基于计算机的系统，用于改善孤立性肺结节（或“肺上的斑点”）患者的管理，孤立性肺结节有时代表肺癌的可治愈形式。通过评估并最终实施该系统，我们的目标是减少非癌性肺结节患者不必要的手术频率，并减少可能导致癌症结节患者错过治愈机会的延迟手术数量。