Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumato

描述(由申请人提供)：为儿科风湿病诊断提供基于证据的决策支持该项目通过招募顶尖风湿病专家将其领域的诊断信息封装在最先进的诊断决策支持软件工具中，以应对儿科风湿病医生的严重短缺。SimulConsult工具在世界各地的神经学和遗传学专家的临床上正在积极使用。本项目关注两个关键的可行性问题，以评估SimulConsult的市场潜力。一个是当增加一个新的、非重叠的临床领域时，诊断性能是否继续保持高水平。第二个问题是多面手和专家是否愿意采用该工具来改善转诊和诊断。目标1是将风湿病添加到现有的诊断决策支持工具中。儿科风湿病的内容将被添加到SimulConsult数据库，使用SimulConsult基于证据的开放数据库方法。使用教科书和文章等叙述性资源作为输入，将为~100个儿科风湿病添加疾病和发现(体征、症状和实验室测试)，以及~200个可能在鉴别诊断中出现的数据库中尚未出现的情况。对于25种疾病的子集，专家将使用基于疾病、基于发现和基于病例的编辑来进一步提炼这些信息，添加专家已知的关于疾病发现的叙述材料中经常省略的数据。目标2是评估诊断的有效性和效率，以及转诊的适当性。在使用诊断决策支持前后，将通过测试临床医生对真实病例的诊断和检查来衡量决策支持软件的功能。测试人员将包括全科医生(儿科医生、家庭医生和急诊科儿科医生)和风湿科高级和初级医生。目标3是评估是否需要修改数据结构，以处理不同医学领域的不同粒度的信息等问题，并制定有效的方法来满足这些需求。SimulConsult中的当前结构，如“修饰性发现”和“捆绑”发现，将根据需要进行评估和修改，以同时向风湿学家和神经遗传学家展示发现。成功加上关于采用还需要什么的投入，将为第二阶段奠定基础，扩大其余275种与儿科风湿病相关的疾病的详细覆盖范围，并为采用做必要的改变。 公共卫生相关性：使医生能够为儿科风湿病诊断提供循证决策支持。该项目通过招募顶尖的风湿病专家，将其领域的诊断信息封装在最先进的诊断决策支持软件工具中，以应对儿科风湿病医生的严重短缺。该项目测试了集成到用于其他医学领域的工具中的可行性，并评估了这种风湿病辅助对风湿病医生和普通临床医生的好处。通过这样做，它测试了这种决策支持方法是否可以更广泛地应用于提高医学的准确性和成本效益。

DESCRIPTION (provided by applicant): Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumatologic Diagnoses This project responds to a critical shortage of pediatric rheumatologists by enlisting top rheumatologists to encapsulate the diagnostic information in their field in the most advanced decision support software tool for diagnosis. The SimulConsult tool is in active clinical use worldwide by specialists in neurology and genetics. This project focuses on two key feasibility questions with which to assess SimulConsult's market potential. One is whether diagnostic performance continues to be high when a new, non-overlapping clinical area is added. The second is whether generalists and specialists are willing to adopt the tool to improve referrals and diagnosis. Aim 1 is to add rheumatology diseases to the existing diagnostic decision support tool. Pediatric rheumatology content will be added to the SimulConsult database, using SimulConsult's evidence-based, open-database approach. Using narrative resources such as textbooks and articles as inputs, diseases and findings (signs, symptoms and lab tests) will be added for the ~100 pediatric rheumatology disease, as well as ~200 conditions not already in the database that are likely to arise in the differential diagnosis. For a subset of 25 diseases this information will be further refined by experts using disease-based, finding-based and case-based editing, adding data frequently omitted from narrative material about findings in a disease but known to experts. Aim 2 is to assess the diagnostic effectiveness and efficiency, and appropriateness of referrals. The functioning of the decision support software will be measured by testing clinicians on diagnosis and workup of real cases, before and after using the diagnostic decision support. Testers will include generalists (pediatricians, family practitioners, and emergency department pediatricians) and rheumatologists, both senior and junior. Aim 3 is to assess whether modifications to the data structure are needed to deal with issues such as different granularity of information in different areas of medicine, and develop effective approaches to those needs. Current structures in SimulConsult such as "modifier findings" and "bundles" of findings will be assessed and modified as necessary to represent findings simultaneously to rheumatologists and neurogeneticists. Success plus input about what else will be needed for adoption will set the stage for a second phase to scale up detailed coverage across the remaining 275 diseases relevant to pediatric rheumatology and to make the required changes for adoption. PUBLIC HEALTH RELEVANCE: Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumatologic Diagnoses. This project responds to a critical shortage of pediatric rheumatologists by enlisting top rheumatologists to encapsulate the diagnostic information in their field in the most advanced decision support software tool for diagnosis. The project tests workability of integration into a tool used in other areas of medicine and assesses the benefits of such rheumatology assistance for both rheumatologists and general clinicians. By doing so, it tests whether this decision support approach can be used more widely to improve accuracy and cost- effectiveness in medicine.