Veterans Like Mine_Cognitive Support for Therapeutic Decision Making

像我这样的退伍军人_治疗决策的认知支持

• 批准号: 8496297
• 负责人: MATTHEW H SAMORE
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8496297
• 关键词: Access to Information; Address; Adopted; Adoption; Algorithms; Area; Back; Big Data; Caring; Clinical; Clinical Data; Clinical Decision Support Systems; Cognitive; Communicable Diseases; Communities; Complex; Data; Databases; Decision Making; Decision Support Systems; Development; Diagnostic; Effectiveness; Electronic Health Record; Elements; Environment; Feedback; Funding; Generations; Hand; Healthcare; Individual; Informatics; Information Resources; Knowledge; Learning; Libraries; Medical; Medical center; Methods; Microbiology; Mining; Natural Language Processing; Outcome; Outpatients; Patient Care; Patients; Pharmacy facility; Physicians; Population; Population Analysis; Practice Guidelines; Process; PubMed; Public Health Informatics; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resource Informatics; Resources; Seeds; Services; Social Network; System; Technology; Testing; Text; Therapeutic; Time; Treatment outcome; Uncertainty; Veterans; Work; antimicrobial; cohort; computer infrastructure; computerized data processing; design; experience; improved; information display; information processing; interest; novel; task analysis; usability

DESCRIPTION (provided by applicant): This project will support the commitment of the VA to improve the care of Veterans via the priority area of health informatics. We propose to develop and implement a novel cognitive support and population-analytic system, called Veterans Like Mine (VLMine), to aid clinicians in providing care to Veterans. The clinical focus of this project is on therapeutic management in infectious diseases in order to maximize synergy with our other CREATE projects, leverage our extensive work validating national microbiology data, and capitalize on the depth of our research team in clinical infectious diseases. Physicians accrue questions about patient care every two to three outpatient encounters, yet more than half of these questions remain unanswered. Currently available resources such as practice guidelines from national associations, PubMed and UpToDate among others are often not adequately detailed or specific enough to provide guidance on individual patient problems. VLMine is planned to serve as an expansive information resource and clinical decision support system that is adaptable to new problems and applicable in any clinical domain. Its anticipated use is in situations that trigger concerns or questions on the part of the clinician because they are unfamiliar, complex, or uncertain. The research aims of this proposal are: (1) Retrieve and analyze population data relevant to therapeutic decisionsat the individual patient level; (2) Execute and display case-matched population inquiries of Veterans Like Mine (VLMine) and (3) Conduct a demonstration study of VLMine for infectious disease clinicians. We also propose an exploratory aim: Extend VLMine to strengthen bridge between experience and evidence. These aims will achieve the following objectives: retrieve data about other patients similar to the individual patient at hand present information to clinicians to facilitate management of diagnostic uncertainty, assessment of treatment options, and prediction of outcomes; provide an interface to promote information foraging, sense-making, and analytic reasoning and provide guidance about therapeutic management by addressing knowledge and experience gaps only partially filled by other information resources. This project will build on the informatics methods that the PI, co-investigators and research team have developed under current VA HSR&D funding and used across multiple research projects to extract information on individual patients and large cohorts of Veterans across the VA. The project will use VA Informatics and Computing Infrastructure (VINCI) as a platform to access national VA data from the Central Data Warehouse (CDW) including administrative data, microbiology results, pharmacy data and clinical text notes. Our partners include Office of Informatics and Analytics, Corporate Data Warehouse, Patient Care Services, the Healthcare Transformation HI2 initiative, and VINCI; they strongly back the development of case-matched population inquiries proposed in this project. This is an opportune time for VA to advance applications of Big Data. VLMine will constitute a new kind of informatics resource, a type that does not currently exist. VLMine will provide VA clinicians access to information which draws upon the collective experience of other clinicians. Processing data from all facilities, it will generate summaries of treatments and outcomes relevant to individual patient care. As both an analytic framework and user environment, VLMine has the potential to transform how clinicians process information and acquire new knowledge.

描述(由申请人提供)： 该项目将支持退伍军人事务部通过保健信息学优先领域改善对退伍军人的护理的承诺。我们建议开发和实施一个新的认知支持和人口分析系统，称为像我一样的退伍军人(VLmy)，以帮助临床医生为退伍军人提供护理。该项目的临床重点是传染病的治疗管理，以便最大限度地与我们的其他CREATE项目协同作用，利用我们验证国家微生物学数据的广泛工作，并利用我们在临床传染病研究团队的深度。每两到三次门诊就诊，医生就会提出关于病人护理的问题，但其中一半以上的问题仍然没有得到回答。目前可用的资源，如来自国家协会、PubMed和UpToDate等的实践指南，往往不够详细或具体，不足以为个别患者的问题提供指导。VLmine计划作为一个扩展的信息资源和临床决策支持系统，能够适应新的问题，并适用于任何临床领域。它的预期用途是在临床医生因不熟悉、复杂或不确定而引发担忧或问题的情况下。这项建议的研究目的是：(1)检索和分析与个体患者层面的治疗决策相关的人口数据；(2)执行和展示像我这样的退伍军人的病例匹配人群查询(VLmine)；(3)为传染病临床医生进行VLmy的示范研究。我们还提出了一个探索性的目标：扩展VLmy，以加强经验和证据之间的桥梁。这些目标将实现以下目标：检索与手头单个患者相似的其他患者的数据；向临床医生提供信息，以便于管理诊断不确定性、评估治疗方案和预测结果；提供一个界面，促进信息搜寻、推理和分析推理，并通过解决其他信息资源仅部分填补的知识和经验空白，提供关于治疗管理的指导。该项目将建立在PI、合作调查人员和研究团队在当前退伍军人管理局HSR&D资金下开发的信息学方法的基础上，并在多个研究项目中使用，以提取退伍军人中个别患者和大群退伍军人的信息。该项目将使用退伍军人事务部信息学和计算基础设施(VINCI)作为平台，从中央数据仓库(CDW)获取国家退伍军人事务部数据，包括行政数据、微生物学结果、药学数据和临床文本笔记。我们的合作伙伴包括信息学和分析办公室、企业数据仓库、患者护理服务、医疗转型HI2计划和Vinci；他们强烈支持该项目中提出的病例匹配人口查询的发展。这是退伍军人管理局推进大数据应用的好时机。VLmy将构成一种新的信息资源，一种目前不存在的类型。VLmy将向退伍军人管理局临床医生提供借鉴其他临床医生集体经验的信息。处理来自所有设施的数据，它将生成与个别患者护理相关的治疗和结果摘要。作为一个分析框架和用户环境，VLmine有可能改变临床医生处理信息和获取新知识的方式。