Improving Guideline Development and Implementation

描述（由申请人提供）：一个长期存在的信息学挑战是开发有效的机制，使有效的医学知识-如实践指南中所包含的知识-可以在支持临床医生决策的系统中操作。然而，一个令人沮丧的障碍，这一目标的满意度一直是指南知识转化为可计算的格式的困难。在这个竞争性的更新应用程序中，我们提出了一个研究计划，将扩展成功的成就。1.认识到模糊和模棱两可的建议阻碍了指南的实施和遵守，我们将建模和描述指南声明中普遍存在的模糊和不确定性的形式，确定这些声明导致临床不确定性的程度，并确定减少这种不确定性的方法。2.与美国儿科学会和美国家庭医生学会合作，我们将开发，安装和评估软件工具，以支持科学有效和可实施的指南的有效创作。与国家专业协会合作提供了一个机会，将上一个赠款期开发的工具和技术转移到真实的世界，在那里它们将得到评估和反复改进。3.我们将通过开发工具来帮助将自然语言建议转化为正式规则，并应用基于行动类型的框架来设计可在国家和地方层面使用的可重复使用的实施策略，从而促进指南知识的实施。4.我们将修改并进一步扩展指南元素模型，以适应对指南文档建模、创作和实现活动至关重要的概念。我们将创建一个XML模式，并为当前用户提供确保其GEM文件保持兼容的功能。此外，我们将把新模型作为拟议标准提交给HL 7和/或ASTM。将指南知识转化为操作决策支持系统的系统化过程可以为提供高质量的循证医疗保健带来实质性好处。此外，拟议的活动侧重于将优先影响儿童-一个特别脆弱的群体-的系统。

DESCRIPTION (provided by applicant): A longstanding informatics challenge has been to develop efficient mechanisms whereby valid medical knowledge - such as that contained in practice guidelines - can be operationalized in systems that support decision making by clinicians. However, a frustrating impediment to the satisfaction of this goal has been the difficulty of translation of guideline knowledge into computable formats. In this competing renewal application we propose a research program that will extend successful accomplishments. 1. Recognizing that vague and ambiguous recommendations impede both guideline implementation and adherence, we will model and characterize the forms of ambiguity and vagueness that are prevalent in guideline statements, ascertain the degree to which such statements lead to clinical uncertainty, and identify methods to diminish this uncertainty. 2. In collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians, we will develop, install, and evaluate software tools that support efficient authoring of scientifically valid and implementable guidelines. Working with the national professional societies offers an opportunity to move the tools and techniques developed in the last grant period into the real world where they will be evaluated and iteratively improved. 3. We will facilitate implementation of guideline knowledge by developing tools to help translate natural language recommendations into formal rules and apply a framework based on action-types to design reusable implementation strategies that can be used at national and local levels. 4. We will modify and further extend the Guideline Elements Model to accommodate concepts that are critical for guideline document modeling, authoring, and implementation activities. We will create an XML Schema and provide capabilities to current users to assure their GEM files remain compatible. Furthermore, we will submit the new model as a proposed standard to HL7 and/or ASTM. A systematic process for translating guideline knowledge into operational decision support systems can have substantial benefits for delivery of high-quality, evidence based health care. In addition, the proposed activities focus on systems that will preferentially impact children - a particularly vulnerable population.