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大力研究循证医学（EBM）实践，并试图将这些指南嵌入到护理中，但很少有人成功地将循证医学整合到护理点。集成的挑战包括临床工作流程的中断、复杂的指导方针难以记忆，以及电子健康记录（EHR）中临床提醒的过度触发。McGinn博士是一位先驱和领导者，在他的AHRQ资助的研究中，他创建了一个创新的综合临床预测规则（iCPRs）到EHR，这导致了高的提供者利用率和不适当的抗生素和诊断测试订单的显着下降。巨大的成功是彻底的试验和可用性测试的结果，以确定将该工具纳入临床工作流程的最佳方法。利用McGinn博士在将心肺复苏术整合到护理中的专业知识，这笔拨款将使他能够在EBM，信息学，可用性测试和心肺复苏术集成方面建立一个专家团队，并为建立一个创新的可用性实验室提供额外的资源。除了可用性团队，我们还将建立一个执行顾问委员会，由国际和国内的EBM专家以及NSLlJ的EBM部门组成。EAB将参加每月的电话会议，对可用性实验室的工作提供反馈，并对他们在传播和整合EBM方面的工作提供见解。我们打算将我们的服务目标定位于NSLlJ的医院，这些医院为保险不足的少数族裔社区服务，特别是南区、森林山和卢医院。该团队的重点是将可用性科学纳入北岸- lij （NSLIJ）目前在EBM方面的努力，并与社区实践合作，在医疗点选择、定制和整合cpr，其目标是：1)创建一个iCPR整合团队，与社区实践和医院合作，在医疗点实施经过验证的cpr； 2)在社区实践和医院医生中增加EBM护理点工具的使用。3)利用NSLlJ的循证医学部门和社区卫生组织目前的努力，创建一个可持续的模式，将循证医学推广到临床实践。

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.