Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumato

为医生提供针对儿科风湿病的循证决策支持

• 批准号: 8394229
• 负责人: MICHAEL M SEGAL
• 金额: $ 20.39万
• 依托单位: SIMULCONSULT, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-19 至 2014-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8394229
• 关键词: Accident and Emergency department; Adopted; Adoption; Area; Child; Childhood; Clinical; Collection; Computer software; Data; Databases; Diagnosis; Diagnostic; Differential Diagnosis; Disease; Effectiveness; Encapsulated; Family; Feedback; General Practitioners; Genetic; Hereditary Disease; Human Resources; Individual; Marketing; Measures; Medicine; Modification; Neurologic; Neurology; Performance; Phase; Physicians; Published Comment; Resources; Rheumatology; Signs and Symptoms; Software Tools; Specialist; Staging; Structure; System; Testing; Textbooks; Time; base; case-based; clinical practice; cost; cost effectiveness; data structure; editorial; empowered; evidence base; improved; medical specialties; neurogenetics; pediatrician; rheumatologist; scale up; success; tool; willingness

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.

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，以增强医生的能力。该项目通过招募顶级风湿病学家，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，以应对儿科风湿病学家的严重短缺。SimulConsult工具在全球范围内被神经学和遗传学专家积极用于临床。该项目侧重于评估SimulConsult市场潜力的两个关键可行性问题。一个是当一个新的、不重叠的临床领域被添加时，诊断性能是否继续保持高水平。第二个是通才和专家是否愿意采用该工具来改善转诊和诊断。目的1是将风湿病添加到现有的诊断决策支持工具中。儿科风湿病学的内容将被添加到SimulConsult数据库，使用SimulConsult的循证，开放数据库的方法。使用教科书和文章等叙述性资源作为输入，将为约100种儿科风湿病添加疾病和发现（体征，症状和实验室检查），以及可能在鉴别诊断中出现的约200种尚未在数据库中的疾病。对于25种疾病的子集，这些信息将由专家使用基于疾病，基于发现和基于病例的编辑进行进一步完善，添加经常从关于疾病发现的叙述材料中省略但专家已知的数据。目的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之前和之后，将通过测试临床医生对真实的病例的诊断和检查来测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）和风湿病学家，包括高级和初级。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“修饰符发现”和“发现束”，将根据需要进行评估和修改，以同时向风湿病学家和神经遗传学家表示发现。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，以扩大对其余275种与儿科风湿病相关的疾病的详细覆盖范围，并为采用做出必要的改变。 公共卫生相关性：为儿科风湿病诊断提供基于证据的决策支持。该项目通过招募顶级风湿病学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来应对儿科风湿病学家的严重短缺。该项目测试了整合到其他医学领域使用的工具中的可行性，并评估了这种流变学援助对流变学专家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用于提高医学中的准确性和成本效益。