A Clinical Decision Support Tool for Electronic Health Records

描述（由申请人提供）：药物滥用治疗往往是复杂的客户端的家庭，就业，精神病，或法律的问题。当这些共存的问题与循证实践（EBP）得到解决时，结果会得到改善。扩大EBP对于药物辅助治疗（MAT）尤其重要，这是许多联邦和州治疗倡议的主题。然而，尽管广泛的努力，教育临床医生通过培训，EBP纳入临床设置继续滞后。如果在服务点可以获得信息，最有可能实施电子商务。这些挑战强烈表明需要一个技术解决方案。该提案旨在通过在药物滥用治疗方面具有全国地位的两家公司- Inflexxion（Newton，MA）和FEi（哥伦比亚，MD）的合作，在电子健康记录（EHR）中开发临床决策支持（CDS）系统。Inflexxion和FEi正在寻求开发行为健康咨询模块（BHAM）。该CDS将“插入”治疗服务网络基础设施（WITS），这是一个由FEi支持的基于网络的EHR。通过将先进的统计技术（潜在类别分析）和数据挖掘应用于广泛的WITS数据集，我们可以评估客户配置文件，交付的服务和结果之间的关系。BHAM可以确定哪些配置文件最适合客户，并提供：（1）量身定制，基于证据的实践建议，以及（2）客户参与策略（已被证明可以改善结果）。在第一阶段，我们：完成了一个模型，包括三个档案的阿片类药物/阿片类药物使用者;开发了一个互动原型的BHAM;并表明接受CDS的概念，由药物滥用专家和临床医生。这一概念也得到了CDS和药物滥用专家顾问的审查和支持。第二阶段的目标是在药物滥用治疗中心充分开发和测试BHAM。现场测试将检查主要假设，即相对于对照条件，分配给BHAM计划的治疗机构的顾问将为其客户提供或提供显着更匹配的循证和概括性服务。我们还将研究在实验条件下，相对于控制条件，接受咨询师治疗的客户在多大程度上显着表现出：（1）更大的治疗参与度，（2）更少的酒精/药物复发，（3）更大的心理社会功能。最后，我们将研究BHAM的成本效益。

DESCRIPTION (provided by applicant): Substance abuse treatment is often complicated by a client's family, employment, psychiatric, or legal problems. When these co-existing issues are addressed with evidence-based practices (EBPs), outcomes improve. The expansion of EBPs is especially important regarding Medication-Assisted Treatment (MAT), which is the subject of a number of federal and state treatment initiatives. However, despite extensive efforts to educate clinicians through training, the integration of EBPs into clinical settings continues to lag. EBPs are most likely to be implemented if information is available at the point of service. These challenges strongly suggest the need for a technical solution. This proposal seeks to develop a clinical decision support (CDS) system within electronic health records (EHRs) through a collaboration of two companies that have developed a national standing in substance abuse treatment - Inflexxion (Newton, MA) and FEi (Columbia, MD). Inflexxion and FEi are seeking to develop the Behavioral Health Advisory Module (BHAM). This CDS will "plug into" Web Infrastructure for Treatment Services (WITS), a web-based EHR supported by FEi. By applying advanced statistical techniques (latent class analysis) and data mining to the extensive WITS dataset, we can assess the relationships between client profiles, delivered services, and outcomes. BHAM can identify which profile best fits a client and provide: (1) tailored, evidence-based practice recommendations, and (2) client engagement strategies (which have been shown to improve outcomes). In Phase I, we: completed a model comprised of three profiles of opiate/opioid users; developed an interactive prototype of BHAM; and demonstrated acceptance of the CDS concept by substance abuse experts and clinicians. The concept was also reviewed and supported by CDS and substance abuse expert consultants. The goal of Phase II is to fully develop and test BHAM in substance abuse treatment centers. The field test will examine the primary hypotheses that, relative to the Control condition, counselors in treatment facilities assigned to the BHAM program will provide or offer their clients significantly greater matched evidence-based and wraparound services. We will also examine the extent to which clients being treated by counselors in the Experimental condition, relative to the Control Condition, demonstrate significantly: (1) greater engagement in treatment, (2) fewer alcohol/drug relapses, and (3) greater psychosocial functioning. And finally, we will examine the cost effectiveness of BHAM.