Building Learning Health System Capacity: Leveraging Lessons from an Evaluation of a SEPSIS Clinical Decision Support Tool

项目摘要 脓毒症是一种临床综合征，定义为因宿主调节失调而导致的危及生命的器官功能障碍。 对感染的反应。与脓毒症相关的负担很大，超过170万成人病例 每年在美国确诊，进而导致27万人死亡。这些临床挑战反映了 脓毒症的治疗费用在美国医院的所有条件中排名最高，占 所有住院费用，而只占所有住院费用的3.6%。诊断和诊断的根本挑战 治疗败血症，从而降低其成本和质量负担，是没有确认性诊断试验的。 相反，脓毒症的诊断需要根据感染和器官功能障碍的证据进行临床判断。 来自多种来源，包括微生物学、药物管理、实验室和 管理/编码数据。克服这些挑战的一种方法是使用临床决策支持 在适当的时间向提供者提供临床知识和患者相关信息的系统 加强对病人的护理。然而，临床决策支持系统在脓毒症护理中的应用还处于起步阶段和 实施方面的挑战没有得到很好的理解。这项混合方法研究的目的是评估 实施临床决策支持系统以了解其对临床的影响和实施 结果。重要的是，临床决策支持系统的实施是在 更大的卫生系统倡议，以成为学习型卫生系统，定义为持续 使用数据和分析来评估和调整实践，以生成知识并实施行为改变 这可以提高质量。因此，这项研究以以下目标为指导：目标1：评估脓毒症的准确性 检测和治疗方案并反复确定扩大方案所需的适应；目标2： 检查脓毒症检测和治疗计划对临床和实施结果的影响； 和目标3：制定整合研究结果的程序，并使学习健康系统方案制度化 评价能力。

Project Summary Sepsis is a clinical syndrome defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. There is significant burden associated with sepsis, with over 1.7 million adult cases diagnosed annually in the U.S., which in turn contribute to 270,000 deaths. These clinical challenges are mirrored in the cost of treating sepsis, which ranks highest among all conditions in U.S. hospitals and represents 13% of all hospital costs while accounting for only 3.6% of all hospital stays. A fundamental challenge to diagnosing and treating sepsis, and thus reducing its cost and quality burden, is that there is no confirmatory diagnostic test. Rather the diagnosis of sepsis requires clinical judgment based on evidence of infection and organ dysfunction provided from multiple sources, including microbiology, medication administration, laboratory, and administrative/coding data. One approach to overcome these challenges is to use clinical decision support systems that provide clinical knowledge and patient-related information to providers at appropriate times to enhance patient care. Yet, the application of clinical decision support systems to sepsis care is in its infancy and challenges to implementation are not well understood. The purpose of this mixed methods study is to evaluate the implementation of a clinical decision support system to understand its effect on clinical and implementation outcomes. Importantly, the implementation of the clinical decision support system occurs in the context of a larger health system initiative to become a Learning Health System, defined as an organization that continuously evaluates and adapts practices using data and analytics to generate knowledge and implement behavior change that can improve quality. Thus, the study is guided by the following aims: Aim 1: Assess fidelity to a sepsis detection and treatment program and iteratively identify adaptations required to scale up the program; Aim 2: Examine the influence of a sepsis detection and treatment program on clinical and implementation outcomes; and Aim 3: Develop a process for integrating study findings and institutionalize Learning Health System program evaluation capacity.