A Model-integrated, Guideline-driven Process Management System for Sepsis

描述（由申请人提供）：本申请解决了广泛的挑战领域（10）处理医疗保健数据的信息技术和特定的挑战主题10-LM-102，复杂临床决策的高级决策支持。背景：脓毒症的特征是继发于感染的全身炎症。它很常见，可以影响任何年龄，种族或性别的个体。在美国，每年诊断出超过75万例病例，在伴有相关器官功能障碍的患者中，死亡率接近30%。患有严重疾病的患者通常需要重症监护室管理，忍受长时间的住院，并消耗大量的医疗资源。越来越多的证据已经出现，以指导脓毒症的管理和改善结果。基本原理：基于证据的建议被广泛用于脓毒症管理，但在重症监护室（ICU）环境中实施具有挑战性。ICU是一个信息密集型的环境，医生的轮换团队通过分析多个时间上不连续的数据来管理重症患者。增加一个复杂的，时间敏感的协议-如败血症治疗所需-加剧了时间和信息管理能力的供需之间的差距。出于这些原因，我们认为ICU环境，特别是脓毒症管理，非常适合技术干预，这将简化脓毒症患者的识别和信息处理，提供及时的决策支持。假设：我们假设，脓毒症的自动识别和电子支持的流程管理将缩短诊断和启动治疗的时间，促进提高对循证管理建议的依从性，并对相关临床结果产生积极影响，例如ICU和医院住院时间和机械通气的要求。方法：我们开发了一套新颖的电子应用程序，充分利用了范德比尔特先进的技术基础设施，在脓毒症相关临床试验中的领导地位，以及强大的医学信息学支持。这些应用程序将持续监测每位患者的电子病历和电子医嘱，以获取提示发生脓毒症的数据，或在诊断为脓毒症的患者中，以获取满足推荐管理指南的证据。这些自动化应用程序将通过实时通知的方式与医生互动，提醒他们脓毒症已经发展的可能性。我们的软件套件将部署在医院无处不在的临床工作站上，将加快败血症患者的识别。其他软件将向医生显示针对患者的循证管理建议，从而大大改善患者护理和结果。我们将设计和部署一套新颖的交互式电子应用程序，以促进脓毒症患者的早期发现，并指导医生进行指南驱动的管理实践。我们假设，这套电子应用程序将导致败血症患者的早期识别，提高医生对败血症管理推荐指南的依从性，并改善患者的临床结局。

DESCRIPTION (provided by applicant): This application addresses the broad challenge Area (10) Information Technology for Processing Health Care Data and specific challenge topic, 10-LM-102, Advanced decision support for complex clinical decisions. BACKGROUND: Sepsis is characterized by systemic inflammation secondary to infection. It is common and can affect individuals of any age, race, or sex. More than 750,000 cases are diagnosed in the United States annually, and among patients with associated organ dysfunction, mortality approaches 30%. Patients with severe disease often require intensive care unit management, endure prolonged hospital stays, and consume substantial healthcare resources. A growing body of evidence has emerged to guide sepsis management and improve outcomes. RATIONALE: Evidenced-based recommendations are widely used for sepsis management but are challenging to implement in the intensive care unit (ICU) setting. The ICU is an information-intensive environment where rotating teams of physicians manage critically ill patients by analyzing multiple, temporally discontinuous pieces of data. Adding a complex, time-sensitive protocol-as required in sepsis treatment-exacerbates the discrepancy between supply and demand for time and information-management capacity. For these reasons, we believe that the ICU setting in general, and sepsis management specifically, are ideally suited for a technology intervention that will streamline identification and information handling in septic patients providing just-in-time decision support. HYPOTHESIS: We hypothesize that automated identification and electronically-supported process management for sepsis will shorten the time to diagnosis and initiation of therapy, facilitate improved compliance with evidence-based management recommendations, and positively impact pertinent clinical outcomes, such as ICU and hospital length of stay and requirement for mechanical ventilation. METHODS: We have developed a novel suite of electronic applications that leverage Vanderbilt's advanced technology infrastructure, leadership in clinical trials related to sepsis, and robust medical informatics support. These applications will constantly monitor the electronic medical record and electronic orders of each patient for data suggestive of developing sepsis, or in patients diagnosed with sepsis, for evidence that recommended management guidelines are being satisfied. These automated applications will interact with physicians by way of real-time notifications to alert them to the possibility that sepsis has developed. Our software suite, to be deployed on the hospital's ubiquitous clinical work stations, will expedite identification of septic patients. Additional software will display patient-specific, evidence-based management recommendations to physicians providing the opportunity for greatly improved patient care and outcomes. We will design and deploy a novel suite of interactive electronic applications to facilitate early detection of septic patients and guide physicians toward guideline-driven management practices. We hypothesize that this suite of electronic applications will result in earlier identification of septic patients, improve physician adherence to recommended guidelines for management of sepsis, and improve clinical outcomes for patients.