Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral in the ED (STIRRED)

通过脂肪变性识别、风险分层和急诊室转诊来提高诊断安全性 (STIRRED)

• 批准号: 10828499
• 负责人: Amy V Kontrick
• 金额: $ 50万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10828499
• 关键词: Improving; Diagnostic; Safety; through; STeatosis

PROJECT ABSTRACT Nonalcoholic fatty liver disease (NAFLD) is a public health crisis affecting one third of the US adult population. NAFLD is an obesity related disease with serious health and quality of life consequences including type 2 diabetes, cirrhosis, liver cancer, and cardiovascular disease. Despite serious threats to health and wellbeing, NAFLD has not received the same attention as other cardiometabolic diseases like type 2 diabetes. In addition, NAFLD is often asymptomatic and patients are frequently diagnosed when hepatic steatosis is reported as an incidental finding on imaging studies or a patient develops advanced liver disease. Our prior work found hepatic steatosis reported in just under 10% of written radiology reports. Unfortunately, lack of awareness often leads to hepatic steatosis being overlooked by providers and unreported to patients leading to delays in diagnosis and referral to specialty care. Our recent survey revealed only 13% of providers always reported this finding to patients. This project, Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral pathway in the ED (STIRRED), proposes to improve diagnostic safety by ensuring that patients receive timely notification of the new finding and referral to follow up care. To date, we have developed the building blocks for the STIRRED CDSS by employing natural language processing and machine learning to identify hepatic steatosis in written emergency department (ED) radiology reports and combine it with common clinical data and comorbidities in the electronic health record to create an individualized risk profile and follow up recommendations for patients with suspected (NAFLD). Providing risk stratified appropriate referrals for patients from the ED will increase diagnosis of NAFLD, enable those deemed high risk for advanced liver disease to receive specialist referral and begin the important process of cancer screening and intervention to improve steatosis. Communicating this incidental imaging finding and initiating referral from the ED will enable linkage to care to improve health outcomes and reverse or slow disease progression for those at all risk levels. While the groundwork for this intervention has been laid, for STIRRED to be successful, it must be both refined further and implemented thoughtfully. Through Aim 1 and 2, we will seek to: 1) determine the barriers, facilitators, and additional strategies to implement the STIRRED CDSS, and 2) conduct usability testing of the STIRRED CDSS. Upon finalizing the optimized STIRRED CDSS and implementation plan, we seek to: 3) evaluate STIRRED across a large health system. This work will be led by a team of experienced researchers with expertise in clinical trials, risk communication, patient communication, diagnostic uncertainty, hepatic steatosis and NAFLD, incidental findings, implementation science, and health services research. Completion of these aims will result in tools to improve care transitions and diagnostic safety for patients with hepatic steatosis and suspected NAFLD. Findings will inform future work to implement STIRRED in EDs nationally and develop ED-based interventions for patients with suspected NAFLD.

项目摘要 非酒精性脂肪性肝病(NAFLD)是一种公共健康危机，影响着三分之一的美国成年人。 非酒精性脂肪肝是一种与肥胖相关的疾病，具有严重的健康和生活质量后果，包括2型 糖尿病、肝硬变、肝癌和心血管疾病。尽管健康和福祉受到严重威胁， NAFLD并没有像其他心脏代谢性疾病如2型糖尿病那样受到同样的关注。此外, NAFLD通常没有症状，当报告肝脏脂肪变性时，患者经常被诊断为 影像检查中的偶然发现或患者发展为晚期肝病。我们之前的工作发现 在书面放射学报告中，略低于10%的病例报告了肝脏脂肪变性。不幸的是，缺乏意识往往 导致肝脏脂肪变性被提供者忽视，也没有报告给患者，导致延误 诊断和转诊至专科护理。我们最近的调查显示，只有13%的供应商总是这样报告 对病人的发现。本项目，通过脂肪变性识别提高诊断安全性，风险 分层和急诊中的转诊路径(STRRED)建议通过以下方式提高诊断安全性 确保患者收到新发现的及时通知和转介以进行后续护理。迄今为止，我们 通过使用自然语言处理和开发了搅拌CDSS的构建块 机器学习识别肝脏脂肪变性的书面急诊科(ED)放射报告和 将其与电子健康记录中的常见临床数据和并发症相结合，创建 对疑似非酒精性脂肪肝(NAFLD)患者的个体化风险描述和随访建议。提供风险 急诊科对患者的分层适当转诊将增加NAFLD的诊断，使那些被认为 晚期肝病高风险接受专家转诊并开始癌症的重要过程 筛查和干预以改善脂肪变性。传达这一偶然的成像发现并启动 ED的转介将使护理联系起来，以改善健康结果并逆转或减缓疾病 对于所有风险水平的人来说都是进步的。虽然这一干预的基础已经奠定，但对于搅动 为了取得成功，它必须进一步完善和深思熟虑地实施。通过目标1和目标2，我们将 寻求：1)确定实施STRISTED CDSS的障碍、促进者和其他战略，以及 2)对搅拌式CDSS进行可用性测试。在最终确定优化的搅拌CDSS和 在实施计划中，我们寻求：3)评估在一个大型卫生系统中激起的影响。这项工作将由 一支经验丰富的研究团队，在临床试验、风险沟通、患者沟通、 诊断不确定性、肝脏脂肪变性和非酒精性脂肪肝、偶然发现、实施科学和健康 服务研究。完成这些目标将产生改善护理过渡和诊断的工具 对肝脏脂肪变性和疑似NAFLD患者的安全性。调查结果将为今后的工作提供指导，以实施 在全国范围内推动急诊室，并为疑似NAFLD患者开发基于ED的干预措施。