Computerized Decision Support for Pediatric Gastroenterology

描述(申请人提供)：循证医学在临床实践中的渗透率很低，导致大量资源浪费，并因不适当或低效的医疗保健而增加发病率和死亡率。计算机化的决策支持已被证明在多个地点大大改善了这一过程。初步工作表明，儿科胃肠病学作为一门专业，在全国范围内的护理方面存在很大差异，这表明需要采取措施，帮助提供者使用循证指南。我们的研究小组开发了一个大型、强大的计算机化决策支持系统，用于儿科初级保健：通过计算机化自动化改善儿童健康(CHICA)。该应用程序的主要目标是使该系统适用于儿科专科设置(CHICA-GI)，并研究其对循证医学的坚持和对临床结果的影响。这一应用的假设是，在儿科胃肠病护理中引入基于证据的计算机化决策支持系统将改善对指南的遵守，以及总体健康结果。将通过实现以下具体目标来检验这一假设：通过修改CHICA系统以支持初级保健环境中便秘的儿科胃肠病指南，从而获得关于目前在初级保健环境中使用的CHICA系统的知识和专业知识(目标1)。建立新版本的CHICA系统，用于儿童胃肠病门诊(CHICA-GI)(目标2)。修改新建立的CHICA-GI系统以支持多个儿科胃肠病指南，并确定CHICA-GI CDSS是否改善了对三个循证指南的遵守以及患者水平的结果(目标3)。此外，该应用程序的职业发展目标包括医疗信息学方面的强化培训，以及沉浸在由健康服务、信息学和儿科胃肠病学方面的知名医生和研究人员围绕的指导环境中。在这个项目结束时，我将建立并深入研究儿科胃肠病学中独特的计算机化决策支持系统，并将准备创建必要的下一代系统，以弥合临床实践和研究之间的差距。

DESCRIPTION (provided by applicant): Evidence-based medicine penetrates poorly into clinical practice, resulting in a large amount of wasted resources and increased morbidity and mortality from inappropriate or inefficient medical care. Computerized decision support has been shown to substantially improve this process in multiple venues. Preliminary work has shown that pediatric gastroenterology as a specialty shows substantial variation in care nationally, indicating the need for measures to aid providers in the use of evidence-based guidelines. Our research group has developed a large, robust computerized decision support system for use in pediatric primary care: the Child Health Improvement through Computerized Automation (CHICA). The primary goal of this application is to adapt this system for use in a pediatric subspecialty setting (CHICA-GI) and study its effects on adherence to evidence-based medicine and on clinical outcomes. The hypothesis of this application is that the introduction of an evidence-based computerized decision support system into pediatric gastroenterology care will improve adherence to guidelines, as well as general health outcomes. This hypothesis will be tested by accomplishing the following specific aims: Gain knowledge and expertise about the CHICA system currently utilized in the primary care setting by modifying the system to support a pediatric gastroenterology guideline for constipation in a primary care setting (Aim 1). Build a new version of the CHICA system for use in the pediatric gastroenterology outpatient clinic setting (CHICA-GI) (Aim 2). Modify the newly built CHICA-GI system to support multiple pediatric gastroenterology guidelines and determine if the CHICA-GI CDSS improves adherence to the three evidence-based guidelines as well as patient level outcomes (Aim 3). Furthermore, the career development goals of this application include intensive training in medical informatics, as well as immersion in a mentoring environment surrounded by established physician-investigators in health services, informatics, and pediatric gastroenterology. At the end of this project, I will have built and intensively studied a unique computerized decision support system in pediatric gastroenterology and will be poised to create the next generation of systems necessary to bridge the gap between clinical practice and research.