Health informatics approaches to reduce missed opportunities in diagnosis of pancreatic cancer

健康信息学方法可减少胰腺癌诊断的错失机会

• 批准号: 10595644
• 负责人: Natalia Khalaf
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595644
• 关键词: Address; Algorithms; Area; Cancer Etiology; Caring; Cessation of life; Clinical; Clinical Informatics; Communication; Computer software; Coupled; Data; Development; Diagnosis; Diagnostic; Dimensions; Early Diagnosis; Educational Background; Effectiveness; Electronic Health Record; Engineering; Environment; Evaluation; Excision; Foundations; Frequencies; Future; Goals; Health; Health Personnel; Health Services; Health Services Research; Healthcare; Healthcare Systems; Human Resources; Hybrids; Incidence; Informatics; Interdisciplinary Study; Interview; Judgment; Knowledge; Lead; Link; Literature; Malignant Neoplasms; Malignant neoplasm of pancreas; Medical Records; Medicine; Mentors; Mentorship; Methodology; Operative Surgical Procedures; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Play; Predictive Value; Prevention; Process; Provider; Public Health Informatics; Records; Research; Research Infrastructure; Research Personnel; Resources; Risk; Risk Factors; Role; Safety; Structure; Study models; Suggestion; Symptoms; System; Testing; Time; Training Activity; Trust; United States National Academy of Sciences; Veterans; Work; anticancer research; base; cancer care; cancer diagnosis; cancer type; career; career development; clinical practice; cohort; comorbidity; effectiveness implementation study; experience; formative assessment; high risk; implementation barriers; improved; informatics tool; innovation; negative affect; novel; pancreatic cancer patients; patient subsets; support tools; tool

Background. Pancreatic cancer is a highly lethal cancer with increasing incidence among Veterans. Early diagnosis offers the best chance of survival, yet only 30% of Veterans with pancreatic cancer are diagnosed at early stages. Our proposal focuses on optimizing early diagnosis of patients with clinical findings suggestive of pancreatic cancer who are at risk for delayed diagnosis through identifying and reducing missed opportunities in diagnosis (MODs). MODs are defined as instances in which post-hoc judgement indicates that alternative decisions or actions could have led to a more timely diagnosis. Significance/Impact. This proposal is centered around the VA HSR&D priority areas of quality and safety and health care informatics. There are few systematic efforts to improve quality of cancer care for Veterans with pancreatic cancer. This proposal is one of the first large-scale efforts to examine the gaps in care for these patients. We propose to develop electronic trigger tools that, when implemented, will have the potential to identify possible missed opportunities to either initiate or complete the diagnostic process for earlier pancreatic cancer diagnosis. Our results will also serve as foundational for developing informatics-based diagnosis tools for several other high-risk conditions, including other cancer types. Innovation. The development of novel decision support tools (e-triggers) to reduce diagnostic delays in pancreatic cancer represents the first e-trigger tool that is centered on pancreatic cancer care and built around a constellation or combination of “red flags” as opposed to a single “red flag” as in all prior works on the topic. Our study is also conceptually innovative because it represent a first step towards moving e-trigger tools to reduce diagnostic delays in pancreatic cancer from the research environment into the clinical setting. Specific Aims. Our goal is to improve the diagnostic process for pancreatic cancer by developing effective decision support tools. We have 3 aims. Aim 1: To identify missed opportunities for pancreatic cancer diagnosis. Aim 2: To develop electronic algorithms (i.e., e-trigger tools) to identify high-risk Veterans with potential missed opportunities for pancreatic cancer diagnosis. Aim 3: To conduct a formative assessment of e- trigger tools to guide future testing and implementation in clinical practice. Methodology. In Aim 1, we will randomly select 500 pancreatic cancer cases from an already established national VA cohort for structured review of their medical records to identify the frequency and types of MODs as well as key patient-, provider-, and system-specific factors linked to these missed opportunities. In Aim 2, based on the findings of Aim 1 and what is known from the literature, we will develop up to 5 e-trigger tools to identify patients at high-risk for potential MODs through automated identification of specific patterns in clinical electronic health record data. In Aim 3 we will perform formative assessment through stakeholder interviews with Veterans, health care providers, and operational personnel to identify barriers and facilitators to implementing developed e-triggers in clinical practice, as well as a host of socio-technical factors. Implementation/Next Steps. The proposed research will develop health care informatics tools to identify opportunities for earlier pancreatic cancer diagnosis among high-risk patient subgroups who warrant diagnostic evaluation. In the next steps, we will examine the effectiveness of our informatics tools (e-trigger tools) to improve quality of pancreatic cancer care in the VA through a hybrid type I effectiveness-implementation study. This multidisciplinary research, along with career development and mentoring plans, will increase knowledge of earlier cancer diagnosis opportunities in the VA and enhance my ability to transition to an independent health services researcher with expertise in health care informatics. The VA is the largest provider of cancer care in the U.S., thus providing the ideal setting for developing and implementing new ways to optimize diagnostic processes in cancer care.

背景胰腺癌是一种高致命性癌症，在退伍军人中发病率越来越高。 早期诊断提供了最好的生存机会，但只有30%的胰腺癌退伍军人被诊断出来 在早期阶段我们的建议侧重于优化临床发现提示患者的早期诊断 通过识别和减少错过的机会， 诊断（MOD）。MOD被定义为事后判断表明替代方案 决定或行动可能导致更及时的诊断。 意义/影响。本提案围绕VA HSR&D的质量优先领域， 安全和保健信息学。很少有系统的努力来提高退伍军人的癌症护理质量 胰腺癌这项建议是第一个大规模的努力，以审查在照顾这些差距， 患者我们建议开发电子触发工具，一旦实施，将有可能识别 可能错过启动或完成早期胰腺癌诊断过程的机会 诊断.我们的研究结果也将作为开发基于信息的诊断工具的基础， 其他高风险疾病，包括其他癌症类型。 创新开发新的决策支持工具（电子触发器），以减少诊断延误， 胰腺癌代表了第一个以胰腺癌护理为中心， 一个星座或组合的“红旗”，而不是一个单一的“红旗”，因为在所有以前的作品的主题。 我们的研究在概念上也是创新的，因为它代表了将电子触发工具移动到 减少胰腺癌从研究环境到临床环境的诊断延迟。 具体目标。我们的目标是通过开发胰腺癌的诊断方法来改善胰腺癌的诊断过程。 有效的决策支持工具。我们有三个目标。目的1：确定胰腺癌错过的机会 诊断.目标2：开发电子算法（即，电子触发工具），以识别高风险退伍军人， 可能错过胰腺癌诊断的机会。目标3：对电子商务进行形成性评估， 触发工具，以指导临床实践中的未来测试和实施。 方法论在目标1中，我们将从已经存在的胰腺癌病例中随机选择500例， 建立国家VA队列，对他们的医疗记录进行结构化审查，以确定频率和类型 以及与这些错失的机会相关的关键患者、提供者和系统特定因素。在 目标2，基于目标1的发现和文献中已知的内容，我们将开发多达5个e触发器 通过自动识别特定模式来识别潜在MOD高风险患者的工具， 临床电子健康记录数据。在目标3中，我们将通过利益相关者进行形成性评估 与退伍军人，医疗保健提供者和运营人员进行访谈，以确定障碍和促进因素， 在临床实践中实施开发的电子触发器，以及一系列社会技术因素。 执行/后续步骤。拟议的研究将开发医疗保健信息学工具，以确定 需要诊断的高危患者亚组中胰腺癌的早期诊断机会 评价在接下来的步骤中，我们将检查我们的信息学工具（电子触发器工具）的有效性，以提高 通过一项混合I型有效性-实施研究评估VA地区胰腺癌护理质量。这 多学科研究，沿着职业发展和指导计划，将增加对早期 癌症诊断的机会，并提高我的能力，过渡到一个独立的健康服务 在医疗保健信息学方面具有专业知识的研究员。退伍军人管理局是美国最大的癌症护理提供者， 从而为开发和实施优化诊断过程的新方法提供了理想的环境， 癌症护理