A Clinical Decision Support Tool for Electronic Health Records

电子健康记录的临床决策支持工具

• 批准号: 8455315
• 负责人: Stephen F Butler
• 金额: $ 76.42万
• 依托单位: INFLEXXION, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8455315
• 关键词: Address; Alcohols; Caring; Client; Clinical; Clinical Decision Support Systems; Clinical Research; Collaborations; Contracts; Data; Data Set; Databases; Development; Electronic Health Record; Employment; Evidence based practice; Family; Funding Agency; Goals; Information Systems; Intelligence; Internet; Legal; Measures; Modeling; Monitor; Multimedia; National Institute of Drug Abuse; Online Systems; Opiates; Opioid; Outcome; Patterns of Care; Performance; Pharmaceutical Preparations; Phase; Process; Professional counselor; Public Health; Recommendation; Regression Analysis; Relative (related person); Research Infrastructure; Self-Administered; Services; Severities; Small Business Innovation Research Grant; Software Tools; Solutions; Substance Abuse Treatment Centers; Substance abuse problem; Symptoms; System; Techniques; Testing; Training; United States National Institutes of Health; Validation; addiction; base; behavioral health; computerized; cost; cost effectiveness; data mining; drug development; drug discovery; drug relapse; evidence base; flexibility; improved; indexing; programs; prototype; psychologic; psychosocial; public health relevance; satisfaction; substance abuse treatment; substance abuser; tool; treatment center

DESCRIPTION (provided by applicant): Substance abuse treatment is often complicated by a client's family, employment, psychiatric, or legal problems. When these co-existing issues are addressed with evidence-based practices (EBPs), outcomes improve. The expansion of EBPs is especially important regarding Medication-Assisted Treatment (MAT), which is the subject of a number of federal and state treatment initiatives. However, despite extensive efforts to educate clinicians through training, the integration of EBPs into clinical settings continues to lag. EBPs are most likely to be implemented if information is available at the point of service. These challenges strongly suggest the need for a technical solution. This proposal seeks to develop a clinical decision support (CDS) system within electronic health records (EHRs) through a collaboration of two companies that have developed a national standing in substance abuse treatment - Inflexxion (Newton, MA) and FEi (Columbia, MD). Inflexxion and FEi are seeking to develop the Behavioral Health Advisory Module (BHAM). This CDS will "plug into" Web Infrastructure for Treatment Services (WITS), a web-based EHR supported by FEi. By applying advanced statistical techniques (latent class analysis) and data mining to the extensive WITS dataset, we can assess the relationships between client profiles, delivered services, and outcomes. BHAM can identify which profile best fits a client and provide: (1) tailored, evidence-based practice recommendations, and (2) client engagement strategies (which have been shown to improve outcomes). In Phase I, we: completed a model comprised of three profiles of opiate/opioid users; developed an interactive prototype of BHAM; and demonstrated acceptance of the CDS concept by substance abuse experts and clinicians. The concept was also reviewed and supported by CDS and substance abuse expert consultants. The goal of Phase II is to fully develop and test BHAM in substance abuse treatment centers. The field test will examine the primary hypotheses that, relative to the Control condition, counselors in treatment facilities assigned to the BHAM program will provide or offer their clients significantly greater matched evidence-based and wraparound services. We will also examine the extent to which clients being treated by counselors in the Experimental condition, relative to the Control Condition, demonstrate significantly: (1) greater engagement in treatment, (2) fewer alcohol/drug relapses, and (3) greater psychosocial functioning. And finally, we will examine the cost effectiveness of BHAM.

描述（由申请人提供）：药物滥用治疗通常因客户的家庭、就业、精神或法律问题而复杂化。当以证据为基础的实践（ebp）解决这些共存的问题时，结果会得到改善。ebp的扩展对于药物辅助治疗（MAT）尤其重要，这是许多联邦和州治疗计划的主题。然而，尽管通过培训对临床医生进行了广泛的教育，但将ebp整合到临床环境中仍然滞后。如果在服务点上有可用的信息，则最有可能实现ebp。这些挑战强烈表明需要技术解决方案。该提案旨在通过两家公司的合作，在电子健康记录（EHRs）中开发临床决策支持（CDS）系统，这两家公司已经在药物滥用治疗方面取得了全国的地位- inflexion（牛顿，马萨诸塞州）和FEi（哥伦比亚，马里兰州）。inflexion和FEi正在寻求开发行为健康咨询模块（BHAM）。该CDS将“插入”国际医疗联盟支持的基于网络的电子病历——治疗服务网络基础设施（WITS）。通过将先进的统计技术（潜在类分析）和数据挖掘应用于广泛的WITS数据集，我们可以评估客户概况、交付的服务和结果之间的关系。BHAM可以确定哪种情况最适合客户，并提供：(1)量身定制的、基于证据的实践建议，以及(2)客户参与策略（已被证明可以改善结果）。在第一阶段，我们完成了一个由阿片类药物/阿片类药物使用者的三个概况组成的模型；开发BHAM的互动原型；并证明了药物滥用专家和临床医生对CDS概念的接受。这一概念也得到了CDS和药物滥用专家顾问的审查和支持。第二阶段的目标是在药物滥用治疗中心充分开发和测试BHAM。现场测试将检验主要假设，相对于对照条件，分配给BHAM项目的治疗设施的咨询师将为他们的客户提供或提供更匹配的循证和全面的服务。我们还将研究在实验条件下接受咨询师治疗的客户，相对于控制条件，显着表现出：(1)更积极地参与治疗，(2)更少的酒精/药物复发，(3)更大的心理社会功能。最后，我们将检查BHAM的成本效益。