Automated Assessment of Pediatric Rome IV Criteria Using Computerized Decision Support

功能性胃肠道疾病（FGID）在儿童和青少年中极为常见， 代表了与胃肠道相关的广泛的疾病，但没有明确的结构， 解剖学或组织病理学原因。FGID给患者和家庭带来了巨大的负担， 患有这些功能障碍的患者具有高得多的卫生保健利用和相关费用。因为有 没有生化标志物或结构异常可用于诊断儿童的这些疾病 客观上，FGIDs根据基于ESTA的罗马标准进行诊断。胃肠病学家 对于许多患有FGIDs的儿科患者的护理，大部分负担继续由普通人承担， 儿科医生，特别是在初步诊断方面。不幸的是，FGID经常被错误地诊断 由初级保健提供者，患者往往等待数月至数年才作出正确的诊断， 有效的治疗已经开始。此外，初级保健提供者往往不知道最近的指导方针， FGID儿童的证据基础发生变化，导致过度使用测试，不适当或 治疗效果不佳，费用增加。鉴于这些信息，我们必须制定干预措施， 针对儿科初级保健提供者，以改善他们对FGID儿童的护理。我们建议 使用结合罗马IV诊断标准的临床决策支持系统（CDSS）， FGIDs的循证护理将提高（1）诊断的准确性和（2）临床护理的有效性。 CDSS在遵循指南和自动诊断方面具有优势，因为它可以提供 向临床医生提供集中的、实时的、患者特定的数据。对指南实施障碍的研究 在工作中表现出多种因素：不熟悉指南，缺乏自我效能，或难以执行 在实践的当前工作流程中的指南组件。CDSS可以克服其中的许多障碍 因为它们与常规存储和检索患者信息的系统集成， 通过在患者就诊时为临床医生提供患者特定的建议，本课题组 IUSM先前开发了一种高效，强大，高度准确的计算机化CDSS，用于 初级保健环境：通过计算机化自动化系统改善儿童健康。我们 假设使用罗马IV标准进行FGID筛查、诊断和管理的自动化将 导致FGID的分辨率提高（主要结局），以及医疗服务利用率降低 （次要结果）。我们建议使用以下具体目标来检验这一假设：（1）扩大和 修改现有的基于计算机的决策支持系统，以筛查0至18岁的儿童 使用罗马IV标准对功能性胃肠道疾病（FGID）进行评估，并提供关于 诊断和管理可能的FGIDs;（2）证明这种方法的可行性和有效性 CHICA FGID模块，用于改善临床护理措施并减少医疗服务的使用。

Functional gastrointestinal disorders (FGIDs) are extremely common in children and adolescents, and represent a wide range of disorders that are related to the gastrointestinal tract, but have no clear structural, anatomic, or histopathologic cause. FGIDs represent an enormous burden on patients and families, and patients with these functional disorders have much higher health care utilization and related costs. As there are no biochemical markers or structural abnormalities that can be used to diagnose these disorders in children objectively, FGIDs are diagnosed according to the symptom-based Rome criteria. While gastroenterologists care for many of the pediatric patients with FGIDs, the majority of the burden continues to be borne by general pediatricians, especially with respect to initial diagnosis. Unfortunately, FGIDs are often diagnosed incorrectly by primary care providers, and patients often wait months to years before a correct diagnosis is made, and effective treatment is begun. Furthermore, primary care providers are often unaware of recent guideline changes or the evidence base for children with FGIDs, leading to overuse of testing, inappropriate or ineffective treatment, and increased costs. Given this information, it is essential that we develop interventions that target pediatric primary care providers to improve their care for children with FGIDs. We propose that using a Clinical Decision Support System (CDSS) that incorporates the Rome IV criteria for diagnosis and evidence-based care for FGIDs will improve the (1) accuracy of diagnosis and (2) effectiveness of clinical care. A CDSS has advantages with respect to guideline adherence and automated diagnosis, because it can provide focused, real-time, patient-specific data to the clinician. Studies of barriers to guideline implementation have shown multiple factors at work: unfamiliarity with a guideline, lack of self-efficacy, or difficulty implementing the guideline components within the current workflow of a practice. CDSS can overcome many of these barriers because they are integrated with systems that routinely store and retrieve patient information and can improve workflow by providing clinicians with patient-specific advice at the time of the patient visit. Our research group at IUSM has previously developed an efficient, robust, highly accurate computerized CDSS for use in the primary care setting: the Child Health Improvement through Computerized Automation (CHICA) system. We hypothesize that automation of screening, diagnosis, and management of FGIDs using the Rome IV criteria will result in improved resolution of FGIDs (primary outcome), as well as decreased utilization of medical services (secondary outcomes). We propose to test this hypothesis using the following specific aims: (1) Expand and modify an existing computer-based decision support system (CHICA), to screen children 0 to 18 years of age for functional gastrointestinal disorders (FGIDs) using the Rome IV criteria, and provide guidance regarding diagnosis and management of probable FGIDs; and (2) Demonstrate the feasibility and effectiveness of this CHICA FGID Module to improve clinical care measures and reduce utilization of healthcare services.