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

项目总结/摘要 本研究将开发、评估和完善一个“诊断驱动”的计算机决策支持系统 (CDS)和纵向警报系统，以提高直接口服的安全性和患者特异性处方， 抗凝剂（DOAC）药物。我们将开发诊断驱动的CDS工具，用于两个最常见的 导致使用DOAC的疾病（房颤和静脉血栓栓塞）。每个都将指导临床医生 通过基于危重患者特征、实验室检查值和并发症的药物和剂量选择 药物使用。以用户为中心的设计原则将成为启发式评估的迭代方法的基础， 可用性测试，以及与15名执业临床医生的半结构化访谈。我们还将开发一个系列， 纵向系统，以持续重新评估DOAC处方的适当性，并在以下情况下提醒临床医生 问题发展。我们会按照人权谘询会认可的“五权”模式， 格式、通道和临床医生工作流中发生这些警报通知的时间。这项研究的结果将 改善安全管理，减少300万患者的药物不良事件 在全国范围内开了DOAC

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.