Leveraging Health IT to Avoid Unnecessary Asymptomatic Carotid Revascularization

利用健康 IT 避免不必要的无症状颈动脉血运重建

• 批准号: 8637508
• 负责人: Philip P Goodney
• 金额: $ 16.11万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8637508
• 关键词: Leveraging; Health; Avoid; Unnecessary; Asymptomatic

DESCRIPTION (provided by applicant): Elderly patients often face high-risk health care decisions about vascular disease, and informed decisions are needed to obtain the best results. Carotid revascularization, via surgical carotid endarterectomy or carotid artery stenting, is among the most frequently performed vascular procedures, and is widely recommended to prevent future stroke. Such treatment is commonly performed for asymptomatic stenosis, where the risk of future stroke is low without intervention, so the potential benefit of intervention is much less than in symptomatic patients. When considering revascularization for asymptomatic carotid stenosis, patients and providers must weigh the up-front risk of surgery against the long-term risk of stroke, taken in the context of the patient's life expectancy. The best decision in ths clinical scenario is revascularization for low-risk patients who will live long enough to benefit from surgery, and medical treatment for higher risk patients with shorter life expectancy. However, providers and policymakers have found it difficult to identify the key variables to inform these decisions, both in terms of the short-term risks of endarterectomy, as well as the long- term risks of stroke or death. Health IT can be leveraged to support two key facets of this health care decision: (1) short-term surgical risk stratification by using detailed patient and procedural variables, such as those present in a clinical registry, and (2) longitudinal follow-up o assess the effectiveness of the revascularization in preventing stroke during the patient's remaining life. Our group has demonstrated that the first component can be established using real world data from a regional registry, and the second can be achieved in a broad, cost-effective manner by using administrative claims data. In the present application, we will develop and implement a merged clinical registry and claims health IT tool that will support clinical decision-making, in the ambulatory setting, for patients with asymptomatic carotid artery disease. This approach leverages the clinical detail present in registries with the complete follow-up available from administrative claims. Specifically, we will: (1) identify which asymptomatic patients are likely to receive unnecessary carotid revascularization, using a merged registry-claims dataset, and design a Health IT tool to convey these findings to providers, and (2) determine the potential cost savings associated with avoiding unnecessary carotid endarterectomy in asymptomatic patients. This health IT tool will identify patients who are least likely to benefit from carotid revascularization and allow patients and providers to make more informed choices in the ambulatory setting regarding medical management versus revascularization. This tool will also serve as a model for broader implementation, through the Society for Vascular Surgery Vascular Quality Initiative, and will inform policy makers about opportunities for reducing health care expenditures by reducing unnecessary care.

描述(申请人提供)：老年患者经常面临血管疾病的高风险医疗决定，需要知情的决定才能获得最佳结果。颈动脉血管重建术，通过外科颈动脉内膜切除术或颈动脉支架植入术，是最常见的血管手术之一，被广泛推荐用于预防未来的中风。这种治疗通常用于无症状的狭窄，因为在没有干预的情况下，未来中风的风险很低，所以干预的潜在好处比有症状的患者要小得多。在考虑无症状颈动脉狭窄的血运重建时，患者和提供者必须权衡手术的前期风险和中风的长期风险，这是根据患者的预期寿命来考虑的。在临床方案中，最好的决定是对将从手术中受益的低风险患者进行血运重建，并对预期寿命较短的高风险患者进行药物治疗。然而，提供者和政策制定者发现很难确定影响这些决定的关键变量，无论是动脉内膜切除术的短期风险，还是中风或死亡的长期风险。医疗信息技术可以被用来支持这一医疗决策的两个关键方面：(1)通过使用详细的患者和程序变量(如临床登记中的变量)进行短期手术风险分层，以及(2)纵向随访，以评估血运重建在患者余生预防中风方面的有效性。我们小组已经证明，第一个组成部分可以使用区域登记处的真实世界数据建立，第二个组成部分可以通过使用行政索赔数据以广泛和具有成本效益的方式实现。在本应用程序中，我们将开发和实施合并的临床登记和索赔健康IT工具，该工具将在门诊环境中支持无症状颈动脉疾病患者的临床决策。这一方法利用了登记处提供的临床细节，并从行政索赔中获得了完整的随访。具体地说，我们将：(1)使用合并的登记-索赔数据集，确定哪些无症状患者可能接受不必要的颈动脉再血管化，并设计一种Health IT工具将这些发现传达给提供者，以及(2)确定与避免无症状患者不必要的颈动脉内膜切除术相关的潜在成本节约。这一健康IT工具将识别最不可能从颈动脉血运重建中受益的患者，并允许患者和提供者 在门诊环境中关于医疗管理与血运重建的更明智的选择。该工具还将通过血管外科学会血管质量倡议作为更广泛实施的典范，并将向政策制定者通报通过减少不必要的护理来减少医疗支出的机会。