Enabling Shared Decision Making to Reduce Harm from Drug Interactions: An End-to-End Demonstration

实现共同决策以减少药物相互作用的危害：端到端演示

• 批准号: 10023271
• 负责人: DANIEL C MALONE
• 金额: $ 49.59万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10023271
• 关键词: Enabling; Shared; Decision; Making; Reduce

PROJECT SUMMARY/ABSTRACT Drug-drug interactions (DDIs) are preventable adverse events that are responsible for 5–14% of adverse drug reactions (ADRs) in hospitalized patients and frequently occur in up to 13% of elderly ambulatory patients. Exposure to life-threatening DDIs continues to occur despite the widespread availability of clinical decision support systems (CDS). Due to Meaningful Use requirements, most electronic health record (EHR) vendors have implemented DDI CDS functionality using the underlying logic provided by drug knowledge-base vendors. A persistent issue is that DDI alerts are overridden at rates as high as 90%. While patients can play a critical role in preventing potentially catastrophic harm due to DDIs, here are very few tools that help them engage in shared decision making about DDI risks. Recently, studies of interactive decision dashboards have shown the potential to foster informed decision making by patients. These decision aids allow patients and clinicians to deliberate together about the advantages and disadvantages of different therapies and arrive at decisions that are concordant with both clinicians' knowledge and patients' preferences. Accordingly, the overarching goal of this study is to advance the DDI CDS frontier beyond physician-centered decision making to patient-centered shared decision making. Our central hypothesis is that interoperable shared decision tools will enhance patient-provider decision making regarding the risks and benefits of interacting medications. The proposed project will use emerging CDS standards (CQL, CDS Hooks, and SMART on FHIR) and a learning health community (CDS Connect) to enable: (i) novel shared decision-making dashboards that graphically communicate risks and decision options related to potential DDIs and (ii) broad interoperability for highly actionable DDI CDS artifacts. Patients and providers will be able to jointly determine the most appropriate actions to mitigate potential harm. We will accomplish our objectives by pursuing the following specific aims: Aim 1: Design and evaluate a user-centered CDS dashboard for shared decision making of drug prescribing concerning risk of DDI harm; Aim 2: Enable contextual DDI CDS rules using CDS Connect; and Aim 3) Conduct a pilot dissemination of the DDI authoring process, the knowledge artifacts, interoperability, and the shared decision-making dashboard. This project will markedly improve CDS for DDIs by simplifying the authoring process and demonstrating interoperable shared patient-physician DDI decision making. We expect patients will value this critical information as part of their care plan and that providers will benefit from risk information that is provided real-time without relying on memory recall. Our novel approach, involving partners across multiple organizations and environments including experts in drug interactions, biomedical informatics, healthcare information technology standards, and shared-decision making will result in safer healthcare with respect to the use of medications.

项目总结/摘要 药物间相互作用（DDI）是可预防的不良事件， 药物反应（ADR）在住院患者中经常发生，在高达13%的老年门诊患者中经常发生。 尽管临床决策广泛可用，但危及生命的DDI暴露仍在继续发生 支持系统（CDS）。由于有意义的使用要求，大多数电子健康记录（EHR）供应商 已经使用药品知识库供应商提供的底层逻辑实现了DDI CDS功能。 一个持续存在的问题是DDI警报被覆盖的比率高达90%。虽然患者可以发挥关键作用， 在预防DDI造成的潜在灾难性损害方面发挥着重要作用，这里有很少的工具可以帮助他们参与 共同制定DDI风险的决策。 最近，对交互式决策仪表板的研究显示出促进知情决策的潜力 由患者制作。这些决策辅助工具允许患者和临床医生共同考虑 不同疗法的优点和缺点，并得出与两者一致的决定 临床医生的知识和患者的偏好。因此，本研究的总体目标是促进 DDI CDS边界超越以医生为中心的决策制定，以患者为中心的共享决策 制作。我们的中心假设是，可互操作的共享决策工具将增强患者-提供者 关于相互作用药物的风险和益处的决策。 拟议的项目将使用新兴的CDS标准（CQL、CDS Hooks和FHIR上的SMART）和 学习健康社区（CDS连接），以实现：（i）新颖的共享决策仪表板， 以图形方式传达与潜在DDI相关的风险和决策选项，以及（ii）广泛的互操作性， 高度可操作的DDI CDS工件。患者和供应商将能够共同确定最 采取适当措施缓解潜在伤害。我们将通过以下方式实现我们的目标 具体目标：目标1：设计和评估以用户为中心的CDS仪表板，用于药物共享决策 关于DDI伤害风险的规定;目标2：使用CDS Connect启用上下文DDI CDS规则;以及 目标3）对DDI编写过程、知识工件、互操作性进行试点传播， 和共享决策仪表板。该项目将通过简化 创作过程并演示可互操作的共享患者-医生DDI决策。我们预计 患者将重视这些关键信息，将其作为其护理计划的一部分，并且提供者将从风险中受益 实时提供的信息，而不依赖于记忆回忆。我们的新颖方法，涉及合作伙伴 跨多个组织和环境，包括药物相互作用、生物医学信息学 医疗保健信息技术标准和共享决策将带来更安全的医疗保健， 尊重药物的使用。