Improving Glaucoma Care Using a Scalable Decision Support System

项目摘要/摘要 通过K23奖项中概述的培训，Brian Stagg博士将成为 利用健康信息技术的卫生服务研究通过增强 青光眼的临床决策，以确保患者得到适当的青光眼护理。 候选人背景：斯塔格博士是该大学专门研究青光眼的助理教授 犹他州。在完成眼科实习后，他完成了为期两年的健康服务研究奖学金。 并获得了健康和医疗研究硕士学位，然后是 杜克大学的青光眼奖学金。他有医疗服务研究、医疗保健的背景经验 投递研究、数据科学和生物统计学。职业发展计划：作为一名成功的 作为独立研究员，Stagg博士需要在以下方面进行额外培训：(1)临床决策支持(CDS)系统 (2)CDS系统设计与人因研究；(3)CDS系统 使用卫生信息学标准整合电子病历，以及(4)研究领导和拨款撰写。这个 本K23中概述的培训和指导将为Stagg博士提供所需的专业知识。导师：通过 犹他大学的支持性研究和指导环境以及他与 来自密歇根大学和杜克大学的导师斯塔格博士将一项创新的 由他的主要导师雷切尔·赫斯博士领导的跨学科指导和咨询团队。临床 问题：在积极接受青光眼治疗的患者中，高达30%的患者仍有明显的视力 视野丢失，需要加强治疗，以降低眼压，防止进一步的损失。恰如其分 这种进行性视野丧失的识别和管理对于预防失明至关重要 青光眼。这对护理青光眼患者的临床医生来说是一个挑战，因为他们必须合并 准确、高效地从多个数据源获取大量纵向数据。优化的工作流程- 适当的CDS系统可以帮助应对这一挑战。CDS系统向临床医生提供信息 改善决策的关注点。具体目标：斯塔格博士将(目标1)理解差异 青光眼临床决策工作流程中眼科专家和全科医生之间的关系 工作量，(目标2)反复改进青光眼CDS系统，并在临床前评估其疗效 设置，并(目标3)将青光眼CDS系统与EHR和Pilot相结合，以确保在 诊所为临床医生提供视野测试频率的个性化建议。完成度 这些目标将导致(1)严格开发、以用户为中心、可扩展的CDS系统，以帮助临床医生 确定青光眼患者的个性化视野测试频率和(2)可概括性 将支持青光眼和其他眼部疾病的未来CDS开发的知识。

PROJECT SUMMARY/ABSTRACT Through the training outlined in this K23 award, Dr. Brian Stagg will become an independent investigator in health services research using health information technology to decrease glaucoma blindness by enhancing clinical decision making for glaucoma to ensure that patients receive appropriate glaucoma care. CANDIDATE BACKGROUND: Dr. Stagg is an Assistant Professor specialized in glaucoma at the University of Utah. Following ophthalmology residency, he completed a 2-year health services research fellowship at the University of Michigan and earned a Master of Health and Healthcare Research degree, followed by a glaucoma fellowship at Duke University. He has background experience in health services research, healthcare delivery research, data science, and biostatistics. CAREER DEVELOPMENT PLAN: To succeed as an independent investigator, Dr. Stagg needs additional training in: (1) Clinical Decision Support (CDS) system workflow and implementation research, (2) CDS system design and human factors research, (3) CDS system EHR integration using health informatics standards, and (4) research leadership and grant writing. The training and mentorship outlined in this K23 will give Dr. Stagg this needed expertise. MENTORS: Through the supportive research and mentorship environment at the University of Utah and his connections with mentors from the University of Michigan and Duke University, Dr. Stagg has put together an innovative interdisciplinary mentoring and advising team lead by Dr. Rachel Hess, his primary mentor. CLINICAL PROBLEM: Up to 30% of patients who are actively treated for glaucoma continue to have significant visual field loss and need intensification of treatment to lower eye pressure and prevent further loss. Proper identification and management of such progressive visual field loss is vital to prevent blindness from glaucoma. This is a challenge for clinicians caring for patients with glaucoma as they must incorporate large amounts of longitudinal data from many data sources accurately and efficiently. Optimized, workflow- appropriate CDS systems can help address this challenge. CDS systems present information to clinicians at the point of care to improve decision making. SPECIFIC AIMS: Dr. Stagg will (Aim 1) understand differences between ophthalmologic specialists and generalists in glaucoma clinical decision-making workflow and workload, (Aim 2) iteratively refine the Glaucoma CDS System and evaluate its efficacy in a pre-clinical setting, and (Aim 3) integrate the Glaucoma CDS System with the EHR and pilot for feasibility and usability in clinics to deliver personalized recommendations to clinicians for visual field testing frequency. The completion of these aims will result in (1) a rigorously developed, user-centered, scalable CDS system to help clinicians determine a personalized visual field testing frequency for patients with glaucoma and (2) generalizable knowledge that will support future CDS development for glaucoma and other eye conditions.