Development of computer aided decision support and EHR alerts for DOAC prescribing

项目摘要/摘要 这项研究将开发、评估和改进一个“诊断驱动”的计算机决策支持系统 (CDS)和纵向警报系统，以改善直接口服的安全和针对患者的处方 抗凝剂(DOAC)药物。我们将针对这两个最常见的问题开发诊断驱动的CDS工具 导致使用DOAC的条件(房颤和静脉血栓栓塞症)。每个人都将指导临床医生 通过基于关键患者特征、实验室价值和并发的药物和剂量选择 药物使用。以用户为中心的设计原则将是启发式评估的迭代方法， 可用性测试，以及对15名执业临床医生的半结构化访谈。我们还将开发一款系列， 纵向系统，持续重新评估DOAC处方的适当性，并在以下情况下提醒临床医生 问题就会产生。遵循AHRQ认可的“五权”模式，我们将评估最可接受的 临床医生工作流程中的格式、渠道和时间，以便这些警报通知发生。这项研究的发现将 改善安全管理，减少三百万患者的药物不良事件 全国范围内的DOAC处方药。

Project Summary/Abstract This study will develop, assess usability of, and refine a a “diagnosis-driven” computer decision support system (CDS) and a longitudinal alert system to improve safe and patient-specific prescribing of direct oral anticoagulant (DOAC) medications. We will develop diagnosis-driven CDS tools for the two most common conditions leading to DOAC use (atrial fibrillation and venous thromboembolism). Each will guide the clinician through drug and dose selection based on critical patient characteristics, laboratory values, and concurrent medication use. User-center design principles will underly an iterative approach of heuristic evaluation, usability testing, and semi-structured interviews with 15 practicing clinicians. We will also develop a serial, longitudinal system to continually re-assess DOAC prescribing appropriateness and alert clinicians when issues develop. Following the “5 Rights” model endorsed by AHRQ, we will assess for the most acceptable format, channel, and time in clinician work flor for these alert notifications to occur. Findings from this study will lead to improvements in safe management and a reduction in adverse drug events for the three million patients prescribed DOACs nationwide.