Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral in the ED (STIRRED)

项目摘要 非酒精性脂肪肝（NAFLD）是一种影响美国三分之一成年人口的公共卫生危机。 NAFLD是一种肥胖相关疾病，具有严重的健康和生活质量后果，包括2型 糖尿病、肝硬化、肝癌和心血管疾病。尽管健康和福祉受到严重威胁， NAFLD没有像其他心脏代谢疾病如2型糖尿病那样受到同样的关注。此外，本发明还提供了一种方法， NAFLD通常是无症状的，并且当肝脂肪变性被报告为一种非酒精性脂肪肝时，患者经常被诊断为NAFLD。 影像学检查的偶然发现或患者发展为晚期肝病。我们之前的研究发现 在书面放射学报告中，肝脂肪变性的报告率略低于10%。不幸的是，缺乏认识往往 导致肝脂肪变性被提供者忽视，未向患者报告， 诊断和转诊到专科护理。我们最近的调查显示，只有13%的供应商总是报告这一点 发现病人。该项目，通过STeatosis识别提高诊断安全性， 分层和艾德转诊途径（STIRRED），建议通过以下措施提高诊断安全性： 确保病人及时得到新发现的通知，并被转介接受后续护理。迄今为止，我们 通过采用自然语言处理，开发了STIRRED CDSS的构建模块， 机器学习，以识别急诊科（艾德）放射学报告中的肝脂肪变性， 联合收割机将其与电子健康记录中的常见临床数据和合并症相结合， 个体化的风险特征和对疑似NAFLD患者的随访建议。提供风险 对来自艾德的患者进行适当的分层转诊将增加NAFLD的诊断， 高危晚期肝病接受专科转诊并开始癌症的重要过程 筛查和干预以改善脂肪变性。传达这一偶然的成像发现，并启动 从艾德转诊将能够与护理联系起来，以改善健康结果并逆转或减缓疾病 对于所有风险水平的人来说。虽然这种干预的基础已经奠定，但对于STIRRED 要取得成功，就必须进一步完善和认真执行。通过目标1和2，我们将 寻求：1）确定实施STIRRED CDSS的障碍、促进因素和其他策略，以及 2)对搅拌CDSS进行可用性测试。在完成优化的搅拌CDSS和 实施计划，我们寻求：3）评估整个大型卫生系统的STIRRED。这项工作将由 一个经验丰富的研究人员团队，在临床试验，风险沟通，患者沟通， 诊断不确定性、脂肪肝和NAFLD、偶然发现、实施科学和健康 服务研究。这些目标的完成将导致工具，以改善护理过渡和诊断 对于肝脂肪变性和疑似NAFLD患者的安全性。调查结果将为今后的工作提供信息， 在全国范围内搅拌ED，并为疑似NAFLD患者制定基于ED的干预措施。

PROJECT ABSTRACT Nonalcoholic fatty liver disease (NAFLD) is a public health crisis affecting one third of the US adult population. NAFLD is an obesity related disease with serious health and quality of life consequences including type 2 diabetes, cirrhosis, liver cancer, and cardiovascular disease. Despite serious threats to health and wellbeing, NAFLD has not received the same attention as other cardiometabolic diseases like type 2 diabetes. In addition, NAFLD is often asymptomatic and patients are frequently diagnosed when hepatic steatosis is reported as an incidental finding on imaging studies or a patient develops advanced liver disease. Our prior work found hepatic steatosis reported in just under 10% of written radiology reports. Unfortunately, lack of awareness often leads to hepatic steatosis being overlooked by providers and unreported to patients leading to delays in diagnosis and referral to specialty care. Our recent survey revealed only 13% of providers always reported this finding to patients. This project, Improving Diagnostic Safety through STeatosis Identification, Risk stratification, and Referral pathway in the ED (STIRRED), proposes to improve diagnostic safety by ensuring that patients receive timely notification of the new finding and referral to follow up care. To date, we have developed the building blocks for the STIRRED CDSS by employing natural language processing and machine learning to identify hepatic steatosis in written emergency department (ED) radiology reports and combine it with common clinical data and comorbidities in the electronic health record to create an individualized risk profile and follow up recommendations for patients with suspected (NAFLD). Providing risk stratified appropriate referrals for patients from the ED will increase diagnosis of NAFLD, enable those deemed high risk for advanced liver disease to receive specialist referral and begin the important process of cancer screening and intervention to improve steatosis. Communicating this incidental imaging finding and initiating referral from the ED will enable linkage to care to improve health outcomes and reverse or slow disease progression for those at all risk levels. While the groundwork for this intervention has been laid, for STIRRED to be successful, it must be both refined further and implemented thoughtfully. Through Aim 1 and 2, we will seek to: 1) determine the barriers, facilitators, and additional strategies to implement the STIRRED CDSS, and 2) conduct usability testing of the STIRRED CDSS. Upon finalizing the optimized STIRRED CDSS and implementation plan, we seek to: 3) evaluate STIRRED across a large health system. This work will be led by a team of experienced researchers with expertise in clinical trials, risk communication, patient communication, diagnostic uncertainty, hepatic steatosis and NAFLD, incidental findings, implementation science, and health services research. Completion of these aims will result in tools to improve care transitions and diagnostic safety for patients with hepatic steatosis and suspected NAFLD. Findings will inform future work to implement STIRRED in EDs nationally and develop ED-based interventions for patients with suspected NAFLD.