Leveraging Health IT to Avoid Unnecessary Asymptomatic Carotid Revascularization

利用健康 IT 避免不必要的无症状颈动脉血运重建

• 批准号: 8733508
• 负责人: Philip P Goodney
• 金额: $ 13.46万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8733508
• 关键词: Leveraging; Health; Avoid; Unnecessary; Asymptomatic

DESCRIPTION (provided by applicant): Elderly patients often face high-risk health care decisions about vascular disease, and informed decisions are needed to obtain the best results. Carotid revascularization, via surgical carotid endarterectomy or carotid artery stenting, is among the most frequently performed vascular procedures, and is widely recommended to prevent future stroke. Such treatment is commonly performed for asymptomatic stenosis, where the risk of future stroke is low without intervention, so the potential benefit of intervention is much less than in symptomatic patients. When considering revascularization for asymptomatic carotid stenosis, patients and providers must weigh the up-front risk of surgery against the long-term risk of stroke, taken in the context of the patient's life expectancy. The best decision in ths clinical scenario is revascularization for low-risk patients who will live long enough to benefit from surgery, and medical treatment for higher risk patients with shorter life expectancy. However, providers and policymakers have found it difficult to identify the key variables to inform these decisions, both in terms of the short-term risks of endarterectomy, as well as the long- term risks of stroke or death. Health IT can be leveraged to support two key facets of this health care decision: (1) short-term surgical risk stratification by using detailed patient and procedural variables, such as those present in a clinical registry, and (2) longitudinal follow-up o assess the effectiveness of the revascularization in preventing stroke during the patient's remaining life. Our group has demonstrated that the first component can be established using real world data from a regional registry, and the second can be achieved in a broad, cost-effective manner by using administrative claims data. In the present application, we will develop and implement a merged clinical registry and claims health IT tool that will support clinical decision-making, in the ambulatory setting, for patients with asymptomatic carotid artery disease. This approach leverages the clinical detail present in registries with the complete follow-up available from administrative claims. Specifically, we will: (1) identify which asymptomatic patients are likely to receive unnecessary carotid revascularization, using a merged registry-claims dataset, and design a Health IT tool to convey these findings to providers, and (2) determine the potential cost savings associated with avoiding unnecessary carotid endarterectomy in asymptomatic patients. This health IT tool will identify patients who are least likely to benefit from carotid revascularization and allow patients and providers to make more informed choices in the ambulatory setting regarding medical management versus revascularization. This tool will also serve as a model for broader implementation, through the Society for Vascular Surgery Vascular Quality Initiative, and will inform policy makers about opportunities for reducing health care expenditures by reducing unnecessary care.

描述（由申请人提供）：老年患者经常面临有关血管疾病的高风险医疗保健决定，并且需要明智的决定以获得最佳结果。颈动脉血运重建是通过手术颈动脉内膜切除术或颈动脉支架支架进行的，是最常执行的血管手术之一，被广泛建议以防止未来的中风。这种治疗通常是针对无症状狭窄的，在没有干预的情况下，未来中风的风险很低，因此干预的潜在益处远低于有症状的患者。在考虑无症状颈动脉狭窄的血运重建时，患者和提供者必须在患者预期寿命的背景下权衡手术的前期风险与长期中风风险。在临床情况下，最好的决定是对低风险患者的血运重建，他们的寿命足够长，可以从手术中受益，以及预期寿命较短的较高风险患者的医疗治疗。但是，提供者和政策制定者发现，很难确定关键变量，以告知这些决定，无论是在内部切除术的短期风险方面以及中风或死亡的长期风险。 可以利用健康来支持这项医疗保健决定的两个关键方面：（1）通过使用详细的患者和程序变量（例如临床注册表中的详细患者和程序变量），以及（2）纵向随访o评估患者在患者剩余的生活中预防中风在预防中风中的有效性。我们的小组表明，可以使用来自区域注册表的现实世界数据来建立第一个组件，并且可以通过使用行政索赔数据以广泛的，具有成本效益的方式实现第二个组件。 在本应用中，我们将开发和实施合并的临床注册中心，并声称健康IT工具，该工具将为无症状颈动脉疾病患者的卧床环境中支持临床决策。这种方法利用注册表中存在的临床细节，并提供了行政索赔的完整后续行动。具体而言，我们将：（1）确定哪些无症状患者可能会使用合并的注册表查询数据集接受不必要的颈动脉血运重建，并设计一种健康IT工具，以将这些发现传达给提供者，并确定与避免避免不必要的颈动脉内膜切除术相关的潜在成本节省。 这种健康的IT工具将确定那些最不可能从颈动脉血运重建中受益的患者，并允许患者和提供者制作 关于医疗管理与血运重建的门诊环境中的更明智的选择。该工具还将通过血管手术协会的血管质量计划，作为更广泛实施的模型，并将通过减少不必要的护理来降低医疗保健支出的机会。