Design of meta-DSS to support the decision-making process: supporting activities on a clinical pathway in the emergency department

在临床决策中，有许多情况下，最终结果是多个相互交织的任务的结果。我想到了在急诊科(ED)管理病人。为了便于患者管理和遵循循证医学，医院引入临床路径作为工具，以确保患者得到最适当的护理。这些途径是根据临床实践指南开发的，它们概述了一系列临时的临床评估和干预措施。从这个意义上说，路径是决策过程的规范模型，各个任务对应于不同的、依赖时间的活动。虽然有为一次支持一项活动而创建的临床DSS，但没有为一组活动提供全面支持的设计方法。本提案所述研究的目的是制定一种设计元决策支持系统的方法，将不同的支助要求和能力结合在一起，以便为整个决策过程提供支助。我们将使用基于组织的多代理系统工程(O-MASE)方法创建一个元决策支持系统设计，该方法允许建模由于代理之间的交互而导致的问题结构的变化(患者管理的常见情况，其中治疗根据最新的评估和以前的操作而变化)。我们将把组成一条路径的单个任务作为独立的代理(实体)来查看，每个代理(实体)都有自己的要求和功能。我们将把这些代理建模为“服务”，它们应该聚集在一起以实现共同的目标。我们将使用面向服务的体系结构(SOA)范例来连接来自临床路径的按需松耦合任务以及由独立临床DSS提供的支持功能。SOA的实现将涉及识别和描述调用与某些特定临床DSS(服务提供者)相关联的单个支持需求的任务(服务请求者)。我们正计划使用临床路径评估Meta-DSS设计用于儿童头部创伤和哮喘的ED治疗的能力。

In clinical decision-making there are many situations where a final outcome is a result of multiple intertwined tasks. Managing a patient in the Emergency Department (ED) comes to mind. In order to facilitate patient management and to follow evidence-based medicine, hospitals introduce clinical pathways as tools to ensure that patients receive the most appropriate care. These pathways are developed from clinical practice guidelines and they outline a sequence of temporal clinical evaluations and interventions. In that sense a pathway is a prescriptive model of a decision-making process with individual tasks corresponding to different, time-dependent activities. While there are clinical DSS created to support one activity at a time, there is no design methodology that provides comprehensive support for a set of activities. The purpose of the research described in this proposal is to develop a methodology for designing a meta-DSS that brings together different support requirements and capabilities so that entire decision-making process is supported. We will create a meta-DSS design using the Organizational-based Multiagent System Engineering (O-MaSE) methodology that allows for modeling changes to the problem structure as a result of interactions between agents (common situation for patient management where treatment changes depending on latest assessment and previous actions). We will be looking at individual tasks comprising a pathway as independent agents (entities), each with its own requirements and capabilities. We will model these agents, as "services" that should be brought together in order to accomplish a common goal. We will use the Service-Oriented Architecture (SOA) paradigm for connecting on demand loosely coupled tasks from a clinical pathway as well as support capabilities provided by stand-alone clinical DSS. The implementation of the SOA will involve identification and description of tasks (service requestors) that invoke individual support requirements associated with some specific clinical DSS (service providers). We are planning to evaluate the capabilities of a meta-DSS design using clinical pathways for ED management of pediatric head trauma and asthma.