Dissemination and Implementation of QT Risk Clinical Decision Support

QT 风险临床决策支持的传播和实施

• 批准号: 10103922
• 负责人: DANIEL C MALONE
• 金额: $ 23.38万
• 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: 2019-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10103922
• 关键词: Dissemination; Implementation; QT; Risk; Clinical

Project Summary: Dissemination and Implementation of QT Risk Clinical Decision Support. Clinical decision support (CDS) for electronic health records (EHR) and prescribing systems has been promoted to improve patient outcomes. Torsades de Pointes (TdP), is a life-threatening arrhythmia associated with the prolongation of the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG). Specifically, TdP is polymorphic ventricular tachycardia preceded by QTc prolongation and usually manifesting as short bursts of ventricular contractions between 160 and 250 beats per minute that occur in rapid succession. A QTc Risk Score (QTc-RS) CDS can calculate the risk for QTc prolongation and assist doctors and other healthcare providers in mitigating the risk of TdP. The central hypothesis of this project is that the dissemination and implementation of a CDS algorithm incorporating the QTc-RS will result in fewer instances of drug-induced prolonged QTc interval, reduce the number of excessive lengths of stay and potentially lead to fewer sudden cardiac deaths. This proposal describes a health information technology research project aimed at the dissemination and implementation of the QTc-RS in a non-profit network of 28 facilities located in five western states that serve rural and urban communities. These facilities are located in regions of the Rocky Mountain west that have a high proportion of underserved American Indian, Latino, and economically disadvantaged populations. We will accomplish our objectives by pursuing the following aims: Aim 1: Adapt, implement, and disseminate a QTc-RS CDS in rural and urban facilities across varying acuity levels within inpatient care facilities; Aim 2: Develop and deliver an educational program on QTc interval prolongation, Torsades de Pointes, and the QTc interval prolongation risk score CDS to health professionals practicing in in-patient environments; Aim 3: Evaluate the effectiveness of a QTc-RS clinical decision support with respect to process changes within facilities, patient focused clinical outcomes, and end-user satisfaction. The proposed project will reduce the risk of QTc prolongation among vulnerable patients while simultaneously ensuring that providers are not overburdened with irrelevant warnings. We recognize that successful CDS implementation requires education and ongoing support. The educational aspects of this project will provide context and rationale for the risk score using a multi-faceted program that will ensure that dissemination and implementation is long-lasting. This project will greatly improve patient safety and improve health care processes by incorporating real-time contextual factors into evidence-based and validated alert algorithms that meet the five “rights” of meaningful CDS. In summary, the project supports the mission of the Agency for Healthcare Research and Quality by improving the quality of healthcare and enhancing patient safety in rural, underserved, and minority populations.

项目摘要：QT风险临床决策支持的传播和实施。 用于电子健康记录（EHR）和处方系统的临床决策支持（CDS）已被 以改善患者的治疗效果。尖端扭转型室性心动过速（TdP）是一种危及生命的心律失常 与心电图（ECG）上的心率校正QT（QTc）间期延长相关。 具体而言，TdP是多形室性心动过速，之前有QTc延长，通常表现为 当心室收缩在每分钟160到250次之间时， 传承为QTc风险评分（QTc-RS）CDS可以计算QTc延长的风险，并协助医生 和其他医疗保健提供者在减轻TdP的风险。 该项目的中心假设是，CDS算法的传播和实施 合并QTc-RS将导致药物诱导的QTc间期延长的情况减少， 住院时间过长的数量，并可能导致更少的心源性猝死。这项建议 描述了一个卫生信息技术研究项目，旨在传播和 在位于西部五个州的28个设施的非营利网络中实施QTc-RS， 为农村和城市社区服务。这些设施位于落基山脉西部的地区， 美国印第安人、拉丁美洲人和经济上处于不利地位的人口比例很高。 我们将通过追求以下目标来实现我们的目标：目标1：调整、实施和传播 农村和城市医疗机构中住院治疗机构内不同紧急程度的QTc-RS CDS; 目标2：制定并提供关于QTc间期延长、尖端扭转型室性心动过速和 QTc间期延长风险评分CDS提供给在住院环境中执业的卫生专业人员; 目的3：评价QTc-RS临床决策支持在以下范围内的过程变更的有效性 设施、以患者为中心的临床结果和最终用户满意度。 拟议的项目将降低脆弱患者QTc间期延长的风险， 同时确保提供者不会因不相关的警告而负担过重。我们认识到 成功实施CDS需要教育和持续的支持。这件事的教育意义 项目将使用多方面的计划为风险评分提供背景和理由，以确保 传播和实施是长期的。该项目将大大提高患者的安全性， 通过将实时环境因素纳入基于证据和经验证的警报， 满足有意义的CDS的五个“权利”的算法。总而言之，该项目支持联合国的使命， 医疗研究和质量机构通过提高医疗质量和增强患者 农村、服务不足和少数民族人口的安全。