Clinical Decision Support for Mild Traumatic Brain Injury

简介（由申请人提供）：候选人：Edward R. Melnick博士是耶鲁大学医学院急诊科助理教授，目前是临床信息学方向健康科学硕士学位课程的学生。他的研究重点是利用计算机临床决策支持（CDS）改善临床实践指南的实施。传统的CDS包括向临床医生提供关于患者特定建议的警报或提醒。梅尔尼克博士在过去五年里发表了13篇同行评议的学术论文。他也是急诊医学国家临床实践指南制定小组的积极成员。Melnick博士研究项目的长期目标是成为一名独立的研究者，其研究项目旨在通过开发系统的以患者为中心的方法，促进透明、共享、知情的决策，以安全降低资源利用率，从而改变急性护理临床遭遇范式。他计划将自己的职业生涯投入到克服有效的CDS的设计挑战，从而将有用，可用，促进共享决策的CDS无缝集成到临床工作流程中。梅尔尼克博士的设计创新将改变医疗保健的交付方式，并随后对所有美国人的患者结果、医疗保健质量、安全、效率、成本和有效性产生重大影响。环境与导师：耶鲁大学医学院急诊医学系为致力于临床研究的内科科学家提供了一个肥沃的环境。本系和大学为专业发展和卓越研究提供了丰富的研究支持和资源。在此期间，梅尔尼克博士将通过完成以下工作来发展他的技能：(1)他正在攻读的临床信息学方向的健康科学硕士学位课程，(2)人机交互、医疗决策、数据库和临床信息系统方面的正式课程，以及(3)在博士的指导下，在CDS、认知任务分析、人因工程、定性研究方法和实施科学方面的目标导向培训活动。希夫曼和波斯特。Shiffman博士是耶鲁大学医学信息学中心的教授和副主任，是一位知名的研究人员，他的工作重点是定义系统和可复制的过程，通过这些过程，指南知识可以转化为CDS。Post博士是耶鲁大学急诊医学副教授和研究主任，是健康信息技术研究方面的专家，他使用定性和混合方法进行研究，包括焦点小组的经验、调查研究和可用性测试。研究项目：该项目的目标是试点一种创新的CDS设计过程，为急诊科（ED）的轻微头部损伤管理生产以患者为中心、有用和可用的CDS。ED是研究过度使用诊断成像的理想场所，因为受伤患者的成像率在十年内增加了两倍，但患者的预后没有明显改善，尽管在轻度颅脑损伤患者中实施了高度敏感和具体的临床决策规则，以检测临床上重要的脑损伤。基于证据的最佳实践

DESCRIPTION (provided by applicant): CANDIDATE: Dr. Edward R. Melnick is an Assistant Professor in the Department of Emergency and currently a student in the Master of Health Science Degree program with Clinical Informatics Track at the Yale University School of Medicine. His research focuses on improving clinical practice guideline implementation using computerized Clinical Decision Support (CDS). Traditional CDS consists of alerts or reminders presented to the clinician regarding patient-specific recommendations. Dr. Melnick has a track record for scholarly productivity with 13 peer-reviewed publications over the last five years. He is also an active member of the national clinical practice guideline development group for emergency medicine. The long-term goal of Dr. Melnick's research program is to become an independent investigator whose research program is aimed at changing the acute care clinical encounter paradigm by developing systematic patient-centered methods that promote transparent, shared, informed decision-making to safely reduce resource utilization. He plans to devote his career to overcoming the design challenges to effective CDS thus incorporating CDS that is useful, usable, promotes shared decision-making, and is seamlessly integrated into clinical workflow. Dr. Melnick's design innovations will change the way that health care is delivered and, subsequently, achieve a significant impact on patient outcomes, health care quality, safety, efficiency, costs, and effectiveness for all Americans. ENVIRONMENT & MENTOR: The Department of Emergency Medicine at the Yale University School of Medicine offers a fertile environment for physician-scientists committed to clinical research. The Department and University offer abundant research support and resources for professional development and research excellence. During the proposed award, Dr. Melnick will develop his skills by completing: (1) his ongoing master's of health science degree program with clinical informatics track, (2) formal coursework in human- computer interaction, medical decision-making, databases, and clinical information systems, and (3) goal- directed training activities in CDS, cognitive task analysis, human factors engineering, qualitative research methods, and implementation science under the mentorship of Drs. Shiffman and Post. Dr. Shiffman, Professor and Associate Director for the Yale Center for Medical Informatics, is a well-established researcher whose work focuses on defining systematic and replicable processes by which guideline knowledge can be translated into CDS. Dr. Post, Associate Professor and Research Director of Emergency Medicine at Yale, is an expert in Health Information Technology research using qualitative and mixed methods including experiences with focus groups, survey research, and usability testing. RESEARCH PROJECT: The objective of this project is to pilot an innovative CDS design process that produces patient-centered, useful, and usable CDS for the management of minor head injury in the emergency department (ED). The ED is the ideal setting to study overuse of diagnostic imaging as imaging rates of injured patients have tripled over ten years without a measurable improvement in patient outcomes, despite implementation of highly sensitive and specific clinical decision rules for detecting clinically important brain injury in minor head injury patients. Evidence-based best practices face barriers to implementation including: lack of awareness, agreement, and adherence. CDS offers a promising strategy to improve guideline implementation. Despite forty years of implementation attempts, CDS has not been universally adopted nor have its benefits been fully realized. Several adoption barriers have been identified with the primary challenge being the "usefulness" (whether it accomplishes its objective) and "usability" (ease-of-use) of the CDS due to poor integration into clinical workflow. This investigation will rely on qualitative methods to identify factors that promote or inhibit the appropriate use of computed tomography (CT) in patients presenting to the ED with minor head injury. Qualitative factors identified in this analysis will b integrated into the design of a patient- centered decision support tool prototype for use by patients and their provider at the bedside. This tool will undergo iterative refinement via rigorou usability testing in the usability lab and the ED in order to maximize its usefulness, efficiency, ease-of-use, user satisfaction, integration into clinical workflow, and ability to promote shared decision-making regarding the appropriate use of CT. The feasibility of implementing this patient- centered decision support at the bedside in a high-volume ED will be provide data for the subsequent clinical trial. The data generated from this pilot is critical to take my research program to the next level-an effectiveness study of the patient-centered decision support tool to safely reduce CT use. This proposal fulfills the Agency for Healthcare Research and Quality (AHRQ) research priority of training investigators in health information technology to improve health care decision-making and support patient-centered care. It will be piloted in the Yale-New Haven ED whose patients include an inner-city population with large minority and low- income groups-two AHRQ priority populations. The tool will include special provisions for shared decision- making with the elderly, another AHRQ priority population.