Automating Heart Failure Data for Patient Treatment Goals at the Point of Care

描述(由申请人提供)： 退伍军人管理局项目总结Garvin 2011：超过90%的患有充血性心力衰竭(CHF)的退伍军人在出院时得到了指南推荐的药物，但β受体阻滞剂的药物往往不是最佳剂量。如果按照随机临床试验中使用的β受体阻滞剂的指南推荐剂量进行治疗，CHF患者的症状管理和存活率会更好。我们从退伍军人综合服务网络(VISN)12进行的初步分析显示，几乎一半有CHF病史的患者没有服用β受体阻滞剂。此外，为CHF患者开出的β受体阻滞剂的剂量仅为指南推荐剂量的一半。应及时对符合指南剂量的药物进行滴定，患者联合护理团队(PACT)的门诊随访是进行滴定的理想环境。我们建议开发一种自动化通信辅助工具，用于与PACT团队在护理点(POC)使用，并检查其使用对CHF护理的影响。在这项拟议的研究中，我们将使用创新的信息学技术，包括信息提取(IE)和自然语言(NLP)技术，并结合实施科学(IS)方法。我们在PACT的背景下将POC定义为提供者评估临床信息并做出护理决策的任何环境。我们将在VISN 12内研究设施的PACT团队中使用安全的通信系统来实施这项援助。为此，我们将与我们的PACT和VISN 12的利益相关者合作，使用促进卫生服务研究实施行动(PARIHS)IS模型中的促进技术，以确定最合适的数据元素来促使β受体阻滞剂滴定，以及使用我们的通信辅助工具将它们呈现给PACT提供者的最佳方式。我们将在临床试验中确定使用通信辅助的临床和成本效益。我们的主要目标是根据指南建议的护理改进β受体阻滞剂的滴定，从而减少患者再入院并改善患者预后。拟议的研究是与休斯顿卓越中心合作开发的四个项目之一，作为加强和推进转型和卓越(CREATE)合作研究的一部分。

DESCRIPTION (provided by applicant): VA Project Summary Garvin 2011: Greater than 90% of Veterans with congestive heart failure (CHF), a high prevalence, high impact disease in veterans, are given guideline-recommended medications at the time of inpatient discharge, yet beta blocker medications are often not at optimal doses. Patients with CHF have better symptom management and survival when treated in accordance with the guideline-recommended dosage of beta blocker that was used in randomized clinical trials. Our preliminary analyses from the Veterans Integrated Service Network (VISN) 12 show that almost one half of the patients with history of CHF are not on a beta blocker. In addition, the doses of beta blockers prescribed for patients with CHF are only half of those recommended by the guidelines. Titration of medications to the guideline concordant doses should be timely and the outpatient follow-up in the Patient Aligned Care Teams (PACT) is the ideal setting to undertake titration. We propose to develop an automated communication aid for use at the point of care (POC) with PACT teams and to examine the impact of its use on CHF care. We will use innovative informatics techniques, including information extraction (IE) and natural language (NLP), techniques coupled with an Implementation Science (IS) approach in this proposed study. We define POC within the context of PACT as any setting where a provider evaluates clinical information and makes a care decision. We will implement this aid with a secure communication system in PACT teams at the study facilities within VISN 12. To this end, in partnership with our PACT and VISN 12 stakeholders, we will use facilitation techniques from the Promoting Action on Research Implementation in Health Services (PARIHS) IS model to identify the most appropriate data elements to prompt beta blocker titration and the best way to present them to PACT providers using our communication aid. We will determine the clinical and cost effectiveness of the use of the communication aid in a clinical trial. Our primary goal is to improve beta blocker titration according to guideline-recommended care thereby reducing patient readmissions and improving patient outcomes. The research proposed is one of four projects developed in partnership with the Houston Center of Excellence as part of the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE).