Dissemination and Implementation of QT Risk Clinical Decision Support

项目摘要：QT风险临床决策支持的传播与实施。 电子健康记录(EHR)和处方系统的临床决策支持(CDS)已经 推广以改善患者的预后。尖端扭矩(TDP)是一种危及生命的心律失常 与心电图上心率校正的QT间期延长有关。 具体地说，TDP是一种多形性室性心动过速，先于QT间期延长，通常表现为 作为每分钟160到250次之间的短时间的室性收缩， 继承。QTC风险评分(QTC-RS)CDS可以计算QT间期延长的风险，并辅助医生 和其他医疗保健提供者在降低TDP风险方面的作用。 该项目的中心假设是CDS算法的传播和实施 纳入QTC-RS将减少药物引起的QTC间期延长的情况，减少 住院时间过长，可能导致较少的心脏性猝死。这项建议 描述了一个卫生信息技术研究项目，旨在传播和 在一个由位于西部五个州的28个设施组成的非营利性网络中实施QTC-RS 服务农村和城市社区。这些设施位于落基山脉以西的地区 有很高比例的未得到充分服务的美国印第安人、拉丁裔和经济弱势群体。 我们将通过实现以下目标来实现我们的目标：目标1：适应、实施和传播 农村和城市机构的QTC-RS CDS，跨越住院护理机构内不同的视力水平； 目标2：开发和提供有关QTC间期延长、尖端扭曲症和 对在住院环境中执业的卫生专业人员的QTC间期延长风险评分CDS； 目的3：评估QTC-RS临床决策支持在以下方面的有效性 设施、以患者为中心的临床结果和最终用户满意度。 拟议的项目将降低脆弱患者QT间期延长的风险，同时 同时确保供应商不会因不相干的警告而不堪重负。我们认识到 成功实施CDS需要教育和持续的支持。这件事的教育方面 项目将使用多方面的计划提供风险评分的背景和理由，以确保 传播和实施是长期的。该项目将极大地提高患者的安全，并改善 通过将实时上下文因素整合到基于证据和验证的警报中，实现医疗保健流程 满足有意义CDS的五个“权利”的算法。总而言之，该项目支持 医疗研究和质量机构通过改善医疗质量和增强患者的能力 农村、服务不足和少数群体的安全。

Project Summary: Dissemination and Implementation of QT Risk Clinical Decision Support. Clinical decision support (CDS) for electronic health records (EHR) and prescribing systems has been promoted to improve patient outcomes. Torsades de Pointes (TdP), is a life-threatening arrhythmia associated with the prolongation of the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG). Specifically, TdP is polymorphic ventricular tachycardia preceded by QTc prolongation and usually manifesting as short bursts of ventricular contractions between 160 and 250 beats per minute that occur in rapid succession. A QTc Risk Score (QTc-RS) CDS can calculate the risk for QTc prolongation and assist doctors and other healthcare providers in mitigating the risk of TdP. The central hypothesis of this project is that the dissemination and implementation of a CDS algorithm incorporating the QTc-RS will result in fewer instances of drug-induced prolonged QTc interval, reduce the number of excessive lengths of stay and potentially lead to fewer sudden cardiac deaths. This proposal describes a health information technology research project aimed at the dissemination and implementation of the QTc-RS in a non-profit network of 28 facilities located in five western states that serve rural and urban communities. These facilities are located in regions of the Rocky Mountain west that have a high proportion of underserved American Indian, Latino, and economically disadvantaged populations. We will accomplish our objectives by pursuing the following aims: Aim 1: Adapt, implement, and disseminate a QTc-RS CDS in rural and urban facilities across varying acuity levels within inpatient care facilities; Aim 2: Develop and deliver an educational program on QTc interval prolongation, Torsades de Pointes, and the QTc interval prolongation risk score CDS to health professionals practicing in in-patient environments; Aim 3: Evaluate the effectiveness of a QTc-RS clinical decision support with respect to process changes within facilities, patient focused clinical outcomes, and end-user satisfaction. The proposed project will reduce the risk of QTc prolongation among vulnerable patients while simultaneously ensuring that providers are not overburdened with irrelevant warnings. We recognize that successful CDS implementation requires education and ongoing support. The educational aspects of this project will provide context and rationale for the risk score using a multi-faceted program that will ensure that dissemination and implementation is long-lasting. This project will greatly improve patient safety and improve health care processes by incorporating real-time contextual factors into evidence-based and validated alert algorithms that meet the five “rights” of meaningful CDS. In summary, the project supports the mission of the Agency for Healthcare Research and Quality by improving the quality of healthcare and enhancing patient safety in rural, underserved, and minority populations.