Engaging patients to enable interoperable lung cancer decision support at scale

项目总结 肺癌是美国癌症相关死亡的主要原因，2020年有超过13.5万人死亡。一个 被称为低剂量计算机断层扫描(LDCT)的筛查测试可以早期发现肺癌并减少肺癌 有大量吸烟史的人的癌症死亡，但这项测试需要患者和他们的 医生根据每个患者的个体风险情况考虑不同的潜在益处和危害。 部分是由于在繁忙的临床中计算和考虑这种特定于患者的风险情况的复杂性 在这种情况下，每年接受筛查的符合条件的患者不到5%。为了解决这一迫切需要，我们 开发了一种名为Decision Precision+的工具，可以分析患者的电子健康记录(EHR)， 促使医生考虑对符合条件的患者进行肺癌筛查，并为医生提供个人- 关于肺癌筛查潜在益处和危害的量身定制的信息。在这样做的时候，决定 Precision+帮助患者和他们的医生做出知情的、以患者为中心的决定 有可能挽救生命的测试。Decision Precision+自2020年来一直在犹他大学健康学院进行临床应用， 符合条件的患者的肺癌筛查率大幅上升。以便帮助其他人 卫生系统提高了适当的肺癌筛查比率，正在做出Precision+决定 可作为免费工具提供给其他组织，可下载并与其自己的EHR系统一起使用。 该项目将在这项有前景的工作的基础上以三种方式进行。首先，我们将构建该工具的一个版本 与患者门户集成，可供患者直接使用。我们将这种工具称为以患者为中心的工具 我的肺健康。医生和卫生系统将能够为符合条件的患者开出MyLonggHealth的处方，因此 他们可以确保他们在电子健康记录中的吸烟情况是准确的，并可以了解到肺癌 对他们来说是合适的，在他们自己舒适的家里。二是把我的健康引入基层医疗 犹他大学和纽约大学的实践，并严格研究增加了多少好处 MyLongHealth在已经可以访问Decision Precision+的临床环境中提供。最后，我们会 研究如何最好地帮助其他卫生系统实施这些工具，我们将开发自助服务资源 以帮助实施。通过这些方式，我们将寻求帮助确保尽可能多的患者 可以从适当的肺癌筛查和相关的肺癌死亡减少中受益。

PROJECT SUMMARY Lung cancer is the leading cause of cancer-related deaths in the US, with over 135,000 deaths in 2020. A screening test known as low-dose computed tomography (LDCT) can detect lung cancer early and reduce lung cancer deaths among individuals with a history of heavy smoking, but this test requires patients and their doctors to consider potential benefits and harms that differ according to each patient’s individual risk profile. Due in part to the complexity of calculating and considering such patient-specific risk profiles in busy clinical settings, less than 5% of eligible patients receive the screening every year. To address this urgent need, we have developed a tool known as Decision Precision+ that analyzes patients’ electronic health records (EHRs), prompts doctors to consider lung cancer screening for eligible patients, and provides doctors with individually- tailored information on the potential benefits and harms of lung cancer screening. In doing so, Decision Precision+ helps patients and their doctors make informed, patient-centered decisions regarding this potentially life-saving test. Decision Precision+ has been in clinical use at University of Utah Health since 2020, and the rate of lung cancer screening among eligible patients has increased dramatically. So as to help other health systems increase their rates of appropriate lung cancer screening, Decision Precision+ is being made available to other organizations as a free tool that can be downloaded and used with their own EHR systems. This project will build upon this promising work in three ways. First, we will build a version of the tool that integrates with the patient portal and can be used directly by patients. We will call this patient-centered tool MyLungHealth. Doctors and health systems will be able to “prescribe” MyLungHealth to eligible patients, so that they can make sure their smoking profile in the EHR is accurate and can learn about whether lung cancer is right for them from the comfort of their own homes. Second, we will introduce MyLungHealth to primary care practices at the University of Utah and New York University and rigorously study how much added benefit MyLungHealth provides in clinical settings that already have access to Decision Precision+. Finally, we will study how best to help other health systems implement these tools, and we will develop self-service resources to help with implementation. In these ways, we will seek to help make sure that as many patients as possible can benefit from appropriate lung cancer screening and the associated reduction in lung cancer deaths.