Development of Single-Screen Clinical Decision Support to Increase Guideline-Based Weight Management and Comorbidity Care

开发单屏临床决策支持以加强基于指南的体重管理和合并症护理

• 批准号: 9789921
• 负责人: Christy Boling Turer
• 金额: $ 8.1万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-21 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789921
• 关键词: Address; Adult; Age; Algorithms; Blood Pressure; Cardiovascular Diseases; Caring; Child; Childhood; Cognitive; Communication; Comorbidity; Complex; Conflict (Psychology); Consensus; Decision Support Model; Decision Support Systems; Decision Trees; Detection; Development; Diagnosis; Diagnostic; Diet; Electronic Health Record; Elements; Engineering; Evaluation; Fast Healthcare Interoperability Resources; Funding; Future; Gender; Goals; Guidelines; Health; Healthcare; Heart Diseases; Height; Hypertension; Informatics; Information Specialists; Internet; Intervention; Laboratory Study; Lead; Life Style; Medicine; Methods; Morbidity - disease rate; Obesity; Obesity Related Hypertension; Obesity associated disease; Overweight; Patients; Pharmaceutical Preparations; Plant Roots; Population; Primary Health Care; Provider; Psyche structure; Publishing; Recommendation; Research; Resistance; Risk Factors; Structure; Techniques; Testing; Time; Update; Variant; Weight; Weight maintenance regimen; Work; base; blood pressure regulation; care delivery; care providers; clinical decision support; clinical practice; computerized; dashboard; disorder prevention; follow-up; heart disease risk; hypertension treatment; improved; operation; pediatrician; point of care; satisfaction; screening; screening guidelines; support tools; symposium; task analysis; tool

PROJECT SUMMARY Obesity-related hypertension is now diagnosed in children. If undiagnosed and untreated, hypertension increases the likelihood of serious health consequences. To address this problem, we must prepare pediatricians, once focused on anticipatory guidance and disease prevention, to surveil and treat children with overweight and obesity for high blood pressure and hypertension. Because blood-pressure norms in children vary with age, gender, and height, it is difficult to identify three blood-pressure elevations to diagnose hypertension. Our long-term goals are to: 1) identify how to support pediatricians in this major practice paradigm shift, 2) improve delivery of guideline-based weight-management and hypertension care, 3) improve long-term weight management, and 4) reduce morbidity from unrecognized obesity-related disease. Our previous studies revealed: (1) specific guideline-recommended weight management clinical practices are effective, but too-rarely used, (2) providers fail to recognize elevated blood pressures in overweight children, (3) determining pediatric hypertension criteria is a complex, error-prone task, and (4) this impediment to hypertension care can be removed by hypertension clinical decision support. These results led us to ask if we could collate and present to providers information needed to deliver both guideline-based weight management and hypertension care. However, in drafting a potential decision-support system, we confronted age and weight-status variations in screening and evaluation guidelines for weight management and hypertension. This led to our central hypothesis that: (1) expert consensus will resolve conflicts and coordinate guideline-based recommendations for weight management and hypertension care, and (2) application of cognitive-engineering methods currently underused in medicine will enable us to build a single-screen weight- management plus hypertension clinical-decision-support interface that is: (1) easy to use (reduces number of task steps needed), (2) error-resistant (limits number of cognitively demanding steps, including mental calculations and recall), and (3) helpful for efficiently identifying and taking action on key information needed to deliver guideline-based weight-management and hypertension care. Our proposed research will broadly impact the field by transforming the current primary-care weight- management clinical practice paradigm to include guideline-based hypertension care. If successful, the resulting clinical-decision-support model can be applied in the future to address other obesity-related comorbidities. Through future funding, the fully developed tool will be used to test whether weight-management plus hypertension clinical decision support improves weight and blood-pressure control. This work holds great potential to support pediatricians in a major practice paradigm shift and delivery of guideline-based weight management and hypertension care. Delivery of this care holds great potential for reducing future cardiovascular disease in adulthood from unrecognized, untreated obesity and hypertension in children.

项目摘要 肥胖相关的高血压现在在儿童中被诊断出来。如果未诊断和治疗，高血压 增加了严重健康后果的可能性。为了解决这个问题，我们必须准备 儿科医生，曾经专注于预期的指导和疾病预防，以监测和治疗儿童与 超重和肥胖的高血压和高血压。因为儿童的血压标准 因年龄、性别和身高不同，很难确定三种血压升高来诊断 高血压我们的长期目标是：1）确定如何支持儿科医生在这一主要做法 范式转变，2）改善基于指南的体重管理和高血压护理的提供，3）改善 长期的体重管理，以及4）减少未被识别的肥胖相关疾病的发病率。 我们先前的研究显示：（1）特定指南推荐的体重管理临床实践 有效，但很少使用，（2）供应商未能认识到超重患者的血压升高 儿童，（3）确定小儿高血压标准是一项复杂的，容易出错的任务，（4）这种障碍 对高血压病的护理可以通过高血压病的临床决策支持。这些结果让我们不禁要问， 我们可以整理并向供应商提供所需的信息， 管理和高血压护理。然而，在起草一个潜在的决策支持系统时，我们遇到了 体重管理筛选和评估指南中的年龄和体重状况变化， 高血压这导致了我们的中心假设：（1）专家共识将解决冲突和协调 基于指南的体重管理和高血压护理建议，以及（2）应用 目前在医学上未充分使用的认知工程方法将使我们能够建立一个单一的屏幕重量， 管理加高血压临床决策支持界面，即：（1）易于使用（减少 任务步骤），（2）抗错误（限制认知要求的步骤，包括心理 计算和回忆），以及（3）有助于有效地识别和采取行动的关键信息， 提供基于指南的体重管理和高血压护理。 我们提议的研究将通过改变目前的初级保健体重来广泛影响该领域- 管理临床实践范例，包括基于指南的高血压护理。如果成功，则 由此产生的临床决策支持模型可以在未来应用于解决其他肥胖相关的问题。 合并症。通过未来的资金，完全开发的工具将用于测试体重管理是否 加上高血压临床决策支持，改善体重和血压控制。这项工作具有很大的 支持儿科医生进行重大实践范式转变和提供基于指南的体重的潜力 管理和高血压护理。提供这种护理具有极大的潜力， 成年期的心血管疾病来自未被认识的、未经治疗的肥胖和儿童高血压。