Spread the Word: Integrating Clinical Prediction Rules at the Point of Care

描述(由申请人提供)：研究人员和临床医生积极研究循证医学(EBM)实践，并试图将这些指南嵌入到护理中，但很少有人成功地在护理点整合循证医学。整合面临的挑战包括扰乱临床工作流程，复杂的指南令人乏味地记忆，以及过度触发电子健康记录(EHR)中的临床提醒。McGinn博士是先驱和领导者，在他的AHRQ资助的研究期间，他在EHR中创建了创新的集成临床预测规则(ICPR)，导致供应商使用率高，不适当的抗生素和诊断性TST排序大幅下降。巨大的成功是彻底的试点和可用性测试的结果，以确定将该工具整合到临床工作流程中的最佳方法。利用McGinn博士在将CPR整合到护理中的专业知识，这笔赠款将使他能够在循证医学、信息学、可用性测试和CPR集成方面发展一支专家团队，并为建立创新的可用性实验室提供额外资源。除了可用性团队，我们还将建立一个执行顾问委员会，由EBM和NSLlJ的EBM部门的国际和国内专家组成。EAB将参加每月的电话会议，就可用性实验室的工作提供反馈，并就他们在传播和整合循证医学方面的工作提供见解。我们打算将我们的服务针对NSLlJ的医院，这些医院为保险不足的少数族裔社区提供服务，特别是南区、森林丘陵和LU医院。该团队的重点将是将可用性科学纳入北岸里约州(NSLIJ)目前在循证医学方面的努力，并与社区实践合作，在护理点选择、定制和整合CPR，目标是1)创建一个ICPR整合团队，他们将与社区实践和医院合作，在护理点实施经过验证的CPR，2)在社区实践和医院医生中更多地使用循证医学护理点工具，以及3)通过利用NSLLJ循证医学部门和社区卫生组织目前的努力，创建将循证医学传播到临床实践的可持续模式。

DESCRIPTION (provided by the applicant): Researchers and clinicians have vigorously researched evidence-based medicine (EBM) practices and have attempted to embed these guidelines into care, yet few have succeeded in the integrating EBM at the point of care. Challenges to integration include the disruption to clinical workflow, complex guidelines that are tedious to memorize, and over triggering of clinical reminders in electronic health records (EHR). Dr. McGinn is a pioneer and a leader and during his AHRQ funded research study, he created an innovative integrated clinical prediction rules (iCPRs) into the EHR, which led to high rates of provider utilization and significant declines in inappropriate antibiotic and diagnostic tst ordering. The large success was a result of thorough pilot and usability testing to determine the best method for incorporating the tool into clinical workflow. Leveraging on Dr. McGinn's expertise in integrating CPR into care, this grant will allow him to develop a team of experts in EBM, informatics, usability testing and integration of CPRs and provide additional resources in establishing an innovative usability lab. In addition to the usability team, we will build an executive advisory board, consisting of international and national experts in EBM and NSLlJ's EBM department. The EAB will attend monthly conference calls to provide feedback on the usability lab's work and insight on their work on dissemination and integration of EBM. We intend to target our services to NSLlJ's hospitals who serve minority communities who are underinsured, specifically Southside, Forest Hills and LU hospitals. The team's focus will be to incorporate the usability science to North Shore-LIJ's (NSLIJ) current efforts in EBM and work with community practices in selecting, tailoring and integrating CPRs at the point of care with the aims of 1) Creating an iCPR integration team who will work with community practices and hospitals to implement validated CPRs at point of care, 2) Increasing use of EBM point of care tools among community practices and hospital physicians, and 3) Creating a sustainable model for disseminating EBM to clinical practices by leveraging on the current efforts of NSLlJ's EBM department and community health organizations.