Shareable, Interoperable Clinical decision Support for Older Adults: Advancing Fall assessment and Prevention Patient-Centered Outcomes Research Findings into Diverse Primary Care Practices (ASPIRE)

为老年人提供可共享、可互操作的临床决策支持：推进跌倒评估和预防以患者为中心的多样化初级保健实践的结果研究结果 (ASPIRE)

• 批准号: 10023772
• 负责人: Patricia C Dykes
• 金额: $ 50万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023772
• 关键词: Shareable; Interoperable; Clinical; decision; Support

ABSTRACT Community-based falls do not have to be a part of healthy aging for older adults. However, fall and injury incidence in the community is a persistent problem amongst community dwellers over the age of 65 years, a rapidly growing population. Sequelae from falls include hip and other fractures, head injuries, fear of falling, and nursing home hospitalization; traumatic and often costly outcomes. Older adults who are at risk for falling are encouraged to take actions to reduce their chances of falling. Our research team is participating in an ongoing community-based fall prevention pragmatic trial, Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), which aims to integrate patient centered fall prevention evidence into primary care settings through use of Falls Care Managers (FCM) and clinical decision support (CDS) that promotes shared fall prevention decision-making. STRIDE is funded by the National Institute of Aging and Patient Centered Outcome Research Institute cooperative agreement number 5U01AG048270. The intended goal of CDS is to use clinical knowledge in the context of patient-specific evidence to support healthcare providers in the process of decision-making. At the center of the STRIDE intervention is software used by an FCM and members of the clinical care team to link patient-specific risk factors to tailored evidence- based interventions to prevent fall-related injuries. The fall prevention plan is then refined using motivational interviewing by the FCM in collaboration with the patient and the primary care team. The current version of the STRIDE software includes the algorithms needed to support evidence-based fall prevention care including shared decision-making with patients, but it also has a number of limitations: 1) it is built in REDCap as a standalone database, separate from the electronic health record (EHR) system used to document patient assessments and other patient care activities, 2) it has been built as an electronic form that is not dynamic and therefore creates unnecessary documentation burden, 3) it does not support busy clinic workflows where assessments must be quickly documented and CDS provided in the context of care provision. These limitations preclude use of the software outside of controlled research settings where there are additional staff to overcome (or “workaround”) the software limitations. Through this project entitled, Advancing Fall ASsessment and PreventIon PatIent-Centered Outcomes REsearch Findings into Diverse Primary Care Practices (ASPIRE), we will overcome these barriers. The goal of the ASPIRE project is to apply the Agency for Healthcare Research & Quality (AHRQ) CDS Connect authoring tool to develop shareable, standards-based fall prevention software that can be posted to the CDS Connect repository. Achieving this goal will address limitations and support wider dissemination of the STRIDE CDS in primary care to support patient and provider fall prevention decision making.

抽象的 社区跌倒不一定是老年人健康老龄化的一部分。然而跌倒和受伤 社区发病率是 65 岁以上社区居民中长期存在的问题， 人口快速增长。跌倒的后遗症包括髋部和其他骨折、头部受伤、害怕跌倒以及 疗养院住院；造成创伤性且往往代价高昂的结果。有跌倒风险的老年人是 鼓励采取行动减少跌倒的机会。 我们的研究团队正在参与一项正在进行的基于社区的跌倒预防实用试验，策略 减少伤害并增强老年人的信心 (STRIDE)，旨在整合以患者为中心的跌倒 通过使用跌倒护理管理器 (FCM) 和临床决策将预防证据纳入初级保健机构 支持（CDS），促进共同的跌倒预防决策。 STRIDE 由国家研究所资助 老龄化和以患者为中心的结果研究所合作协议编号 5U01AG048270。这 CDS 的预期目标是在患者特定证据的背景下使用临床知识来支持 决策过程中的医疗保健提供者。 STRIDE 干预的核心是软件 由 FCM 和临床护理团队成员使用，将患者特定的风险因素与定制的证据联系起来 预防跌倒相关伤害的干预措施。然后使用激励措施完善跌倒预防计划 FCM 与患者和初级保健团队合作进行面谈。 当前版本的 STRIDE 软件包含支持基于证据的跌倒所需的算法 预防护理包括与患者共同决策，但它也有一些局限性：1） 内置于 REDCap 作为独立数据库，独立于用于以下目的的电子健康记录 (EHR) 系统 记录患者评估和其他患者护理活动，2) 它已构建为电子表格， 不是动态的，因此会产生不必要的文档负担，3）它不支持繁忙的诊所 必须快速记录评估并在提供护理的情况下提供 CDS 的工作流程。 这些限制阻止在受控研究环境之外使用该软件 额外的人员来克服（或“解决方法”）软件限制。通过这个名为“前进”的项目 跌倒评估和预防 以患者为中心的结果 对多样化初级保健的研究结果 实践（ASPIRE），我们将克服这些障碍。 ASPIRE 项目的目标是应用 医疗保健研究与质量机构 (AHRQ) CDS Connect 创作工具，用于开发可共享、 基于标准的防坠落软件，可以发布到 CDS Connect 存储库。实现 这一目标将解决局限性并支持在初级保健中更广泛地传播 STRIDE CDS 支持患者和提供者预防跌倒的决策。