A Clinical Decision Support Tool for Electronic Health Records

描述(由申请人提供)：药物滥用治疗通常因客户的家庭、工作、精神疾病或法律问题而变得复杂。当这些共存的问题通过循证实践(EBP)得到解决时，结果会有所改善。EBPS的扩大对于药物辅助治疗(MAT)尤其重要，这是许多联邦和州治疗倡议的主题。然而，尽管通过培训对临床医生进行了广泛的教育，但将EBPS整合到临床环境中仍然滞后。如果在服务点有信息可用，则最有可能实施EBPS。这些挑战强烈表明需要一种技术解决方案。这项提议寻求通过两家公司的合作，在电子健康记录(EHR)中开发一个临床决策支持(CDS)系统，这两家公司已经在药物滥用治疗方面建立了全国地位--Inflexion(马萨诸塞州牛顿)和FEI(马里兰州哥伦比亚)。Inflexion和Fei正在寻求开发行为健康咨询模块(BHAM)。这个CDS将“插入”治疗服务网络基础设施(WITS)，这是一个由FI支持的基于网络的电子病历。通过将先进的统计技术(潜在类别分析)和数据挖掘应用到广泛的WITS数据集，我们可以评估客户概况、提供的服务和结果之间的关系。BAM可以识别最适合客户的配置文件，并提供：(1)量身定制的、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：完成了一个由阿片剂/阿片类药物使用者的三个档案组成的模型；开发了Bham的互动原型；并展示了药物滥用专家和临床医生对CDS概念的接受。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全面开发和测试Bham。现场测试将检验基本假设，即相对于控制条件，分配给Bham计划的治疗设施中的咨询师将为他们的客户提供或为其客户提供显著更匹配的循证和综合服务。我们还将检查客户在实验条件下接受顾问治疗的程度，与控制条件相比，显著表现为：(1)更多地参与治疗，(2)更少的酒精/药物复发，以及(3)更好的心理社会功能。最后，我们将检查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.