Integrated, Individualized, Intelligent Prescribing (I3P)

集成、个体化、智能处方（I3P）

• 批准号: 8700883
• 负责人: Joshua C. Denny
• 金额: $ 75.07万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700883
• 关键词: Academic Medical Centers; Algorithms; Area; Attitude; Behavior; Boxing; Cardiac; Caring; Clinical; Colorectal Cancer; Community Health Networks; Community Health Systems; Computerized Medical Record; DNA; Data; Decision Making; Diagnosis; Drug Prescriptions; Ecosystem; Electronic Health Record; Environment; Evaluation; Future; Gene Mutation; General Hospitals; Genes; Genetic; Genetic Markers; Genetic screening method; Genomics; Genotype; Health; Healthcare; Healthcare Systems; Historically Black Colleges and Universities; Hospitals; Human Genome Project; Individual; Informatics; Institution; Internet; Label; Laboratories; Leadership; Link; Malignant Neoplasms; Malignant neoplasm of lung; Mediator of activation protein; Medical center; Medicine; Methods; Metric; Military Personnel; Mission; Morbidity - disease rate; Mutation; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacogenomics; Physicians; Population; Preventive; Probability; Procedures; Process; Provider; Reaction; Recommendation; Relative (related person); Reporting; Research; Research Infrastructure; Resources; Role; Simvastatin; Site; Structure; Surveys; System; Test Result; Testing; Therapeutic; Time; Toxic effect; Translations; Underrepresented Minority; United States Food and Drug Administration; Variant; Veterans; Vision; Warfarin; Wisconsin; Work; base; biobank; clinical practice; clinically significant; clopidogrel; computerized; improved; knowledge base; knowledge translation; lung melanoma; malignant breast neoplasm; medical schools; meetings; melanoma; mortality; programs; public health relevance; response; social stigma; tool; treatment program; tumor

A widely-held vision arising from the Human Genome Project is use of newly available genetic information to guide preventive and therapeutic decision making in individual patients. One therapeutic area that seems particularly ripe to test this concept is pharmacogenomics, the idea that variability in therapeutic response includes a genomic component. Common variation in both germline and somatic tumor genes is an increasingly well-recognized contributor to variability in drug response, and as a result, recommendations for genotype-guided therapy are being promulgated. Through leadership in multiple genomic networks, Vanderbilt has been at the forefront of pharmacogenomic discovery and translation of this knowledge into clinical practice locally. However, few institutions or practitioners have the procedures and tools in place to incorporate genetic data into routine drug prescribing. In this proposal, we move toward this practice by establishing a program for integrating genomic medicine in diverse healthcare settings. The purpose of the Integrated, Individualized, and Intelligent Prescribing (I3P) project is to perform a multi-site demonstration that integrating genetic data within electronic health records (EHRs) can improve healthcare. We will establish the processes and infrastructure necessary to disseminate clinical genetic testing, results reporting, and decision support into diverse hospital and EHR environments. This application focuses on pharmacogenomics, given the role of adverse drug reactions (ADRs) as major causes of morbidity and mortality, the increasing number of recognized variants included in US Food and Drug Administration (FDA) labels as mediators of both efficacy and toxicity, and the relative lack of stigma attached to carriers of variants in "pharmacogenes." The project will build on two ongoing, clinical genotyping efforts at Vanderbilt: 1) the Pharmacogenomic Resource for Enhanced Decisions In Care and Treatment (PREDICT) program, which prospectively tests patients for 184 high-value germline pharmacogenomic variants including those associated with clopidogrel, warfarin and simvastatin; and 2) the Personal Cancer Medicine Initiative (PCMI), which routinely performs multiplex tumor gene mutation testing in lung cancer and melanoma to direct therapy. I3P will leverage the existing expertise, informatics, and laboratory infrastructure and resources at Vanderbilt to implement genomic medicine in three diverse healthcare systems at "early adopter" sites. These healthcare systems include underserved, minority populations (Nashville General Hospital at Meharry Medical College), military populations (Nashville Veterans Affairs Medical Center), and a community health system (Aurora Health Care).

从人类基因组计划中产生的一个广泛持有的愿景是使用新的可用的遗传基因， 信息，以指导个体患者的预防和治疗决策。一 药物基因组学似乎是检验这一概念的一个特别成熟的治疗领域， 治疗反应的变异性包括基因组成分。常见变异 生殖系和体细胞肿瘤基因是一个越来越公认的贡献者， 药物反应的变异性，因此，基因型指导治疗的建议是 正在颁布。通过领导多个基因组网络，范德比尔特一直在 药物基因组学发现的最前沿，并将这些知识转化为临床 在当地实践。然而，很少有机构或从业人员具备这些程序和工具 将基因数据纳入常规药物处方。在这份提案中，我们朝着这一点迈进， 通过建立将基因组医学整合到各种医疗保健中的计划来实践 设置.综合、个性化和智能处方（I3 P）项目的目的是 进行多地点演示，将遗传数据整合到电子健康中， 电子病历（EHR）可以改善医疗保健。我们将建立流程和基础设施， 传播临床基因检测，结果报告和决策支持， 不同的医院和EHR环境。该应用程序侧重于药物基因组学， 药物不良反应（ADR）作为发病率和死亡率的主要原因， 美国食品药品监督管理局（FDA）认可的变体数量不断增加 标签作为疗效和毒性的介质，以及相对缺乏附加的耻辱， 药物基因变异的携带者。“该项目将建立在两个正在进行的，临床 范德比尔特的基因分型工作：1）用于增强决策的药物基因组学资源 护理和治疗（PREDICT）计划，该计划前瞻性地对患者进行184项高价值 生殖系药物基因组学变体，包括与氯吡格雷、华法林和 辛伐他汀; 2）个人癌症医学倡议（PCMI），该倡议定期进行 肺癌和黑色素瘤的多重肿瘤基因突变检测，以指导治疗。I3 P将 利用现有的专业知识、信息学和实验室基础设施和资源， 范德比尔特将在“早期”在三个不同的医疗保健系统中实施基因组医学 adopter”网站。这些医疗保健系统包括服务不足的少数民族人口（纳什维尔 梅哈里医学院总医院）、军人（纳什维尔退伍军人事务部 医疗中心）和社区卫生系统（奥罗拉卫生保健）。