AUTOMATED CARDIAC DECISION SUPPORT SYSTEM IMPROVES CARE

描述（由申请人提供）：心血管疾病仍然是美国死亡率和发病率的主要原因。为了帮助医疗从业者将新的信息整合到临床实践中，专业组织，如国家胆固醇教育计划专家治疗小组（ATP III），美国心脏协会（AHA），美国心脏病学会（ACC），专家治疗小组（ATP III），预防、检测、评估和治疗高血压全国联合委员会（JNC VI），制定指南，促进心血管疾病管理中的循证护理标准。尽管这些指南具有综合性和广泛传播性，但目标参数并未实现，患者也没有得到最佳管理。这些疾病包括实现血脂和血压目标，冠状动脉疾病和心房颤动患者使用抗血小板或抗凝治疗，心肌梗死后患者使用-受体阻滞剂，收缩期左心室功能障碍患者使用-受体阻滞剂和转换酶抑制剂。为了便于在日常医疗实践中纳入这些治疗指南，心脏目标计划软件已经开发出来，可以根据使用已建立的指南的I级或A级建议，将对心血管疾病管理至关重要的数据及时输入到带有提醒系统的标准化计算机表格中。我们的第一阶段提案侧重于将两家医院的计算机化实验室信息系统连接到我们的心脏目标计划，从而使数据输入过程的大部分“自动化”，并显着减少数据输入所需的时间和精力。该II期提案的目的是在一项多地点临床试验中评估修订后的软件，以评估该软件是否提高了心血管连续体（从心力衰竭到冠状动脉疾病到心房颤动）的护理质量。我们还将采用可用性方法，包括对医生、护士和医生助理的深度访谈和焦点小组，并根据从业者的反馈对现有软件进行改进，并重新测试可行性。如果这个自动化的临床信息和决策支持系统是成功的和广泛的实施，从慢性心血管疾病护理的最佳结果可能实现。

DESCRIPTION (provided by applicant): Cardiovascular disease continues to be the leading cause of mortality and morbidity in the United States. To assist health care practitioners in their integration of new information into clinical practice, professional organizations such as the National Cholesterol Education Program Expert Treatment Panel (ATP III), American Heart Association (AHA), American College of Cardiology (ACC), and Expert Treatment Panel (ATP III), Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), develop guidelines to promote evidence-based standards of care in the management of Cardiovascular disease. Despite the comprehensive nature and widespread dissemination of these guidelines, target parameters are not being achieved, and patients are not managed optimally. These diseases include achievement of lipid and blood pressure goals, usage of antiplatelet or anticoagulant therapy in patients with coronary artery disease and atrial fibrillation, usage of beta-blockers in patients post myocardial infarction, and the usage of beta-blockers and converting enzyme inhibitors in patients with systolic left ventricular dysfunction. To facilitate the incorporation of these treatment guidelines in everyday medical practice, the Cardiac Goal Program software has been developed to prompt entry of data essential to the management of cardiovascular disease, based on Class I or Grade A recommendations using established guidelines, into standardized, computerized forms with a reminder system. Our Phase I proposal focuses on the linking of two hospitals' computerized laboratory information system to our Cardiac Goal Program, thereby "automating" a substantial part of the data entry process and significantly reducing the time and effort required for data entry. The aims of this Phase II proposal are to evaluate the revised software in a multi-site clinical trial to assess whether the software improves the quality of care across the cardiovascular continuum, from heart failure to coronary artery disease to atrial fibrillation. We will also employ usability methodologies, including in-depth interviews and focus groups with physicians, nurses, and physicians' assistants, and refine the existing software based on the feedback from the practitioners and retest the feasibility. If this automated clinical information and decision support system is successful and widely implemented, the best outcomes from care for chronic cardiovascular disease may be achieved.