Decision Support for Safer Surgery (DS3)

描述（由申请人提供）：QCMetrix, Inc.提议扩展国家手术质量改进计划（NSQIP）的优势，开发、实施和评估一个软件系统，即更安全手术决策支持（DS3）。DS3将告知护理提供者手术患者的特定风险，以及实时最小化这些风险的循证护理流程，并将促进外科护理改进项目（SCIP）措施的收集。CMS外科护理改进计划（SCIP）的绩效衡量是复杂的，需要积极的实施策略。国家外科质量改进计划（NSQIP）从参与的医院收集手术数据，并将风险调整后的手术结果报告给医院。该提案的基本原理是启动NSQIP从回顾性数据收集和报告到实时数据收集和临床决策支持的第一步。DS3的目标是帮助医护人员提高SCIP措施的表现，减少手术并发症。项目目标：1)建立风险模型，协助患者风险评估，审核和确认SCIP护理流程。2)实施临床决策支持系统，并将其整合到医护人员的工作流程中。3)在两家医院测试DS3。4)测量并解决术前实施决策支持的障碍。5)测量两家医院DS3实施对SCIP流程措施一致性的影响。项目的方法。这是一个为期3年的快速通道提案。在为期6个月的1期计划研究中，我们将更新先前构建的围手术期手术部位感染、心肌梗死和心脏骤停、深静脉血栓形成、术后肺炎和死亡率的风险模型。我们会进行实地考察，收集DS3系统的需求，并为第2阶段准备规划文件。第二阶段是一个为期30个月的实施项目，我们将实施DS3原型，将该系统与现有的卫生信息系统连接起来，并在两家医院对原型进行现场测试。我们将培训护理人员如何使用该系统，并收集使用情况统计数据。我们会进行调查，记录用户体验和用户意见，并会在系统推出前后，检讨与SCIP措施的一致性。的好处。减少手术并发症是全国关注的焦点。我们期望所提出的决策支持系统在手术护理的工作流程中发挥重要作用。患者将受益于该系统，因为它的重点是减少手术并发症。护理提供者将从该系统中受益，因为循证护理过程将变得更加一致和有效。医院将在经济上受益，因为该系统旨在降低手术并发症的成本，并将满足按绩效付费的标准。

DESCRIPTION (provided by applicant): QCMetrix, Inc. proposes to expand upon the strengths of the National Surgical Quality Improvement Program (NSQIP) to develop, implement, and evaluate a software system, Decision Support for Safer Surgery (DS3). DS3 will inform the care provider of patient-specific risks for surgery and of evidence-based processes of care that will minimize these risks in real- time, and will facilitate the collection of Surgical Care Improvement Project (SCIP) measures. The CMS Surgical Care Improvement Program's (SCIP) performance measures are complex and will need aggressive implementation strategies. The National Surgical Quality Improvement Program (NSQIP) collects surgical data from participating hospitals and reports risk-adjusted surgical outcomes back to the hospital. The rationale for this proposal is to initiate the first steps of taking the NSQIP from retrospective data collection and reporting to real-time data collection and clinical decision support. The goals of DS3 are to assist care providers in improving performance on the SCIP measures and reducing surgical complications. Project Objectives. 1) Develop risk models to assist in patient risk evaluations and review and affirm SCIP processes of care. 2) Implement and integrate a clinical decision support system into the workflow of the care providers. 3) Test DS3 in two hospitals. 4) Measure and address barriers to implementation of decision support in the preoperative setting. 5) Measure the effect of DS3 implementation on concordance with SCIP process measures for the two hospitals. Project Methods. This is a 3-year Fast-Track proposal. In phase 1, a 6-month planning study, we will update the risk models previously constructed for perioperative surgical site infections, myocardial infarction and cardiac arrest, deep vein thrombosis, postoperative pneumonia, and mortality. We will conduct site visits to gather requirements for the DS3 system and we will prepare a planning document for Phase 2. In Phase 2, a 30-month implementation project, we will implement a DS3 prototype, link the system to existing health information systems, and live test the prototype at two hospitals. We will train care providers in the use of the system and will collect usage statistics. We will conduct surveys to document user experience and user opinion and will examine concordance with the SCIP measures before and after the introduction of the system. Benefits. Reducing surgical complications is a national focus. We expect the proposed decision support system to be instrumental in the workflow of surgical care. Patients will benefit from this system because it is focused on the reduction of surgical complications. Care providers will benefit from the system because the evidence-based care process will be made more consistent and efficient. Hospitals will benefit economically because the system is intended to reduce the cost of surgical complications and will meet pay-for-performance criteria.