Refinement and enhancement of a web-based risk calculator deployment system

描述(由申请人提供)：改进和增强基于网络的风险计算器部署系统。由于风险预测不是针对单个患者量身定做的，因此医疗决策的质量受到影响。此外，现有的风险模型和工具没有被广泛使用，因为它们不容易使用，或者不有用，或者两者兼而有之。有能力从统计模型中提供床边预测，从而进行持续的风险评估，将代表着重大进展，并有可能对临床医生和患者如何做出治疗决策产生广泛和重大的影响。我们已经开始开发基于网络的基础设施，使统计员能够快速生成在线风险计算器，以促进预测模型的应用。这项建议的目标是增强和广泛扩展我们的风险计算器构造器，该构造器旨在提供针对单个患者的风险估计。没有其他通用的在线风险计算器可用。该基础设施旨在通过使非程序员可以非常轻松地创建用户友好的风险计算器应用程序，来快速加快将风险方程转化为临床实践的过程。该工具对统计学家和最终用户(例如临床医生)都是免费的，双方都很容易使用，可以在任何网络浏览器(包括黑莓)上运行。虽然我们有一个正在工作的测试版，但在它获得广泛接受之前，我们需要对其进行大幅增强和扩展。因此，我们的目标是1)扩展现有功能。创作和临床医生界面都将受益于附加功能，包括对更广泛的输入变量格式和更具表现力的有效性约束的支持、包括附加的预定义统计模型、扩展的文档和注释功能、提供“撤销”功能以及更灵活的发布功能。这些改进大多涉及对现有编辑工具及其相应的计算器生成和评估组件的更改。2)开发新功能。我们将改变底层系统架构，使其能够在执行风险计算时即时推算存在的缺失值，并在结果矩阵中安排多个预测，以生成比较效率表等功能。3)修改底层基础设施，提高健壮性。需要对系统性能进行细微的调整，包括使用更系统的方法测试一些新引入的功能和修订以确保一致性，增加对更多种平台的支持，以及更智能地使用现有的网络浏览器功能。我们希望开发该系统的监视能力，以捕获和分析有关计算器使用的统计数据，并倾向于观察到的问题。综上所述，这项技术具有很高的创新性，可以应用于许多医疗决策，这是一个非常广泛的影响。它有可能从根本上影响几乎任何可以开发统计模型的医疗决策领域。 公共卫生相关性：当面临复杂的医疗决定时，如果预测的结果是针对个别患者量身定做的，医生和患者可以做出更好的决定。没有一种经济有效的方法可以实现这种精确的定制。我们正在开发一种易于使用的在线工具，允许根据患者的个体特征预测患者的结果。如果我们的工具被广泛采用，它有可能从根本上影响医疗决策，并对所有医生的行医方式产生广泛影响。

DESCRIPTION (provided by applicant): Refinement and enhancement of a web-based risk calculator deployment system .The quality of medical decision making suffers because risk predictions are not tailored to the individual patient. Further, available risk models and tools are not widely used because they are not easy to use, not useful, or both. Having the ability to provide bedside predictions from statistical models that permit continuous risk estimation would represent major progress and has the potential for broad and significant impact on how clinicians and patients make treatment decisions. We have begun to develop a web-based infrastructure that allows statisticians to quickly produce an online risk calculator to facilitate application of prediction models. The goal of this proposal is to enhance and broadly expand our risk calculator constructor, which is designed to provide risk estimations tailored to the individual patient. No other generic online risk calculator is available. The infrastructure is designed to rapidly accelerate the translation of risk equations to clinical practice by making the process very easy for a nonprogrammer to create a user- friendly risk calculator application. The tool is free to both statistician and end-user (e.g., clinician), easy to use by both parties, and runs on any web browser (including the BlackBerry's). Although we have a working beta version, we need to enhance and expand it considerably before it will gain widespread acceptance. Therefore, we aim to 1) extend the existing functionality. Both the authoring and clinician interfaces would benefit from additional functionality, including support for a wider variety of input variable formats and more expressive validity constraints, inclusion of additional predefined statistical models, extended documentation and annotation capabilities, provision of an "undo" feature, and more flexible publishing capabilities. Most of these enhancements involve changes to the existing editing tool and their corresponding calculator generation and evaluation components. 2) develop new functionality. We will change the underlying system architecture so it will be capable of on-the-fly imputation of missing values present when performing risk calculations, as well as arranging multiple predictions in a matrix of results to generate comparative effectiveness tables, among other functions. 3) revise the underlying infrastructure and improve robustness. Minor tweaks are needed to smooth system performance, including testing some newly introduced features and revisions using a more systematic methodology to assure consistency, adding support for a wider variety of platforms, and more intelligent use of available web-browser capabilities. We would like to develop the system's surveillance capabilities to capture and analyze pertinent statistics on calculator use and tend to observed problems. In summary, this technology is highly innovative and can be applied to many medical decisions, which is a very broad impact. It has the potential to radically affect almost any area of medical decision making where statistical models can be developed. PUBLIC HEALTH RELEVANCE: When faced with complex medical decisions, physicians and patients could make much better decisions if predicted outcomes were tailored to the individual patient. No cost-effective method is available that permits this precise tailoring. We are developing an easy-to-use online tool that allows patient outcome to be predicted based on the patient's individual characteristics. If our tool is widely adopted, it has the potential to radically affect medical decision making and to have a broad impact on how all physicians practice medicine.