Evidence Based Decision Making: Integrating Clinical Prediction Rules into Electr

描述（由申请人提供）：临床预测规则（CPRs）是一线决策辅助工具，可帮助医生做出基于证据的、具有成本效益的决策，从而使患者受益。cpr是经过验证的工具，可将证据转化为实践，在降低成本的同时提高质量，可供医生在各种临床环境中使用，如初级保健办公室、急诊室和医院。虽然多年来已经开发并验证了许多cpr，但卫生保健提供者尚未将其纳入日常护理。cpr帮助提供者评估患者病史、体格检查和基本实验室结果的个别组成部分的影响，以估计疾病的可能性或对治疗的潜在反应。预测规则使用的数据是在遇到患者时随时可用的，通常可以减少不必要的治疗和诊断测试。cpr不同于提醒系统或警报系统，因为cpr涉及病史和体格检查的各个方面，并以基于证据的方式估计概率、预后、

DESCRIPTION (provided by applicant): Clinical prediction rules (CPRs) are frontline decision aids that help physicians make evidence-based, cost effective decisions that benefit their patients. CPRs are proven tools that translate evidence into practice, increase quality while reducing costs, and can be used by physicians in a wide variety of clinical settings, such as primary care offices, emergency rooms, and hospitals. While many CPRs have been developed and validated over the years, health care providers have yet to incorporate them into everyday care. CPRs aid providers in assessing the impact of individual components of a patient's history, physical examination, and basic lab results to estimate probability of disease or potential response to a treatment. Prediction rules use data that is readily available at the time of a patient encounter and often reduce unnecessary treatments and diagnostic testing. CPRs differ from reminder systems or alerts in that CPRs pull in aspects of the history and physical exam and in an evidence based fashion estimate probabilities, prognosis, or make treatment recommendations. The goal of this study is to utilize patient electronic health records to incorporate CPRs into the face-to-face patient encounter. We propose to select certain clinical situations where well-validated CPRs are available and likely to be needed on a frequent basis. We will randomly assign an integrated CPR versus usual care into the point of care and evaluate the impact of this integration on doctor behavior and evidence-based decision making. Mount Sinai's Division of General Internal Medicine (DGIM) has significant experience with all aspects of CPRs, including derivation, validation, implementation, and systematic review. Furthermore, the Division has developed an interactive web library of CPRs for clinical use that is one of the most widely sites of its kind. We propose to collaborate with Epic, one of the nation's largest and most respected electronic medical record (EMR) companies, to integrate validated CPRs into EMRs and assess the impact on provider behavior and patient care.