Dataset Information

A patient-oriented clinical decision support system for CRC risk assessment and preventative care.

ABSTRACT:

Background

Colorectal Cancer (CRC) is the third leading cause of cancer death among men and women in the United States. Research has shown that the risk of CRC associates with genetic and lifestyle factors. It is possible to prevent or minimize certain CRC risks by adopting a healthy lifestyle. Existing Clinical Decision Support Systems (CDSS) mainly targeted physicians as the CDSS users. As a result, the availability of patient-oriented CDSS is limited. Our project is to develop patient-oriented CDSS for active CRC management.

Methods

We implemented an online patient-oriented CRC CDSS for the public to learn about CRC, assess CRC risk levels, understand personalized CRC risk factors, and seek professional advices for people with CRC concerns. The system is implemented based on the Django Model-View-Controller (MVC) framework with an extensible background MySQL database. A CRC absolute risk prediction model is applied to calculate the personalized CRC risk score with a user-friendly web survey. An interactive dashboard using advanced data visualization technics will display and interpret the risk scores and factors. Based on the risk assessment, a structured decision tree algorithm will provide the recommendations on customized CRC screening methods. The CDSS also provides a search function for preferred providers and hospitals based on geographical information and patient preferences.

Results

A prototype of the patient-oriented CRC CDSS has been developed. It provides an open assessment of potential CRC risks via an online survey. The CRC risk predictive model has been implemented. The prediction outcomes of risk levels and factors are presented to the users through a personalized interactive visualization interface, to guide the public on how to reduce the CRC risks by changing their living styles (such as smoking and drinking) and diet characteristics (such as consumptions of red meat and milk). The CDSS will also provide customized recommendations on screening methods based on the corresponding risk factors. For users seeking professional clinicians, the CDSS also provides a convenient tool for searching nearby hospitals and available doctors based on the location preferences and providers characteristics (such as gender, language, and specialty).

Conclusions

This CRC CDSS prototype provides a patient-friendly interface for CRC risk assessment and gives a personalized interpretation on important CRC risk factors. It is a useful tool to educate the public on CRC, to provide guidance on minimizing CRC risks, and to promote early CRC screening that reduces the CRC occurrences.

SUBMITTER: Liu J

PROVIDER: S-EPMC6284274 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

A patient-oriented clinical decision support system for CRC risk assessment and preventative care.

Liu Jiannan J Li Chenyang C Xu Jing J Wu Huanmei H

BMC medical informatics and decision making 20181207 Suppl 5

<h4>Background</h4>Colorectal Cancer (CRC) is the third leading cause of cancer death among men and women in the United States. Research has shown that the risk of CRC associates with genetic and lifestyle factors. It is possible to prevent or minimize certain CRC risks by adopting a healthy lifestyle. Existing Clinical Decision Support Systems (CDSS) mainly targeted physicians as the CDSS users. As a result, the availability of patient-oriented CDSS is limited. Our project is to develop patient ...[more]

PMID: 30526596

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Project description:Rationale & objectiveThe study aimed to develop, implement, and evaluate a clinical decision support (CDS) system for chronic kidney disease (CKD) in a primary care setting, with the goal of improving CKD care in adults.Study designThis was a cluster randomized trial.Setting & participantsA total of 32 Midwestern primary care clinics were randomly assigned to either receive usual care or CKD-CDS intervention. Between April 2019 and March 2020, we enrolled 6,420 patients aged 18-75 years with laboratory-defined glomerular filtration rate categories of CKD Stage G3 and G4, and 1 or more of 6 CKD care gaps: absence of a CKD diagnosis, suboptimal blood pressure or glycated hemoglobin levels, indication for angiotensin-converting enzyme inhibitor or angiotensin receptor blocker but not prescribed, a nonsteroidal anti-inflammatory agent on the active medication list, or indication for a nephrology referral.InterventionThe CKD-CDS provided personalized suggestions for CKD care improvement opportunities directed to both patients and clinicians at primary care encounters.OutcomesWe assessed the proportion of patients meeting each of 6 CKD-CDS quality metrics representing care gap resolution after 18 months.ResultsThe adjusted proportions of patients meeting quality metrics in CKD-CDS versus usual care were as follows: CKD diagnosis documented (26.6% vs 21.8%; risk ratio [RR], 1.17; 95% CI, 0.91-1.51); angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescribed (15.9% vs 16.1%; RR, 0.95; 95% CI, 0.76-1.18); blood pressure control (20.4% vs 20.2%; RR, 0.98; 95% CI, 0.84-1.15); glycated hemoglobin level control (21.4% vs 22.1%; RR, 1.00; 95% CI, 0.80-1.24); nonsteroidal anti-inflammatory agent not on the active medication list (51.5% vs 50.4%; RR, 1.03; 95% CI, 0.90-1.17); and referral or visit to a nephrologist (38.7% vs 36.1%; RR, 1.02; 95% CI, 0.79-1.32).LimitationsWe encountered an overall reduction in expected primary care encounters and obstacles to point-of-care CKD-CDS utilization because of the coronavirus disease 2019 pandemic.ConclusionsThe CKD-CDS intervention did not lead to a significant improvement in CKD quality metrics. The challenges to CDS use during the coronavirus disease 2019 pandemic likely influenced these results.FundingNational Institute of Diabetes and Digestive and Kidney Diseases (R18DK118463).Trial registrationclinicaltrials.gov Identifier: NCT03890588.

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Project description:BACKGROUND:Suicide is a global public health concern, but it is preventable. Increased contact with primary care before the suicide or attempted suicide raises opportunities for intervention and prevention. However, suicide assessment and management are areas that many general practitioners (GPs) find particularly challenging. Previous research has indicated significant variability in how GPs understand, operationalize, and assess suicide risk, which subsequently has an impact on clinical decision making. Clinical decision support systems (CDSS) have been widely implemented across different health care settings, including primary care to support practitioners in clinical decision making. A CDSS may reduce inconsistencies in the identification, assessment, and management of suicide risk by GPs by guiding them through the consultation and generating a risk assessment plan that can be shared with a service user or with specialized mental health services. OBJECTIVE:Our aim is to co-develop and test with end users (eg, GPs, primary care attendees, mental health professionals) an electronic clinical decision support system (e-CDSS) to support GPs in the identification, assessment, and management of suicidality in primary care. METHODS:Ours is an ongoing embedded mixed-methods study with four phases: (1) qualitative interviews with GPs to explore their views on the content, format, and use of the e-CDSS, as well as consultation with two service-user advisory groups (people aged ≤25 and people aged ≥25) to inform the content of the e-CDSS including phrasing of items and clarity; (2) participatory co-production workshops with GPs, service users, and clinical experts in suicidality to determine the content and format of the e-CDDS; gain consensus of the relevance of items; establish content validity and identify pathways to implementation, using the Consolidated Framework for Implementation Research; (3) building the e-CDSS so that it guides the GP through a consultation; and (4) usability testing of the e-CDSS with GPs and service users in one primary care practice involving a nonlive and a live stage. RESULTS:The study was funded for four years, to take place between 2015 and 2019, and is currently completing phase 4 data collection. The first results are expected to be submitted for publication in June 2019. The findings will enable us to evaluate the feasibility, acceptability, and usability of a suicide-specific, electronic, guided decision support system in primary care. CONCLUSIONS:This study will be the first to explore the feasibility, acceptability, and usability of an electronic, guided decision support system for use in primary care consultations for the improved assessment and management of suicidality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR1-10.2196/11135.

Dataset Information

A patient-oriented clinical decision support system for CRC risk assessment and preventative care.

Background

Methods

Results

Conclusions

Publications

A patient-oriented clinical decision support system for CRC risk assessment and preventative care.

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