We plan to develop decision support interventions in three clinical areas: coronary artery disease, diabetes mellitus and prevention. Since submitting our proposal, we have chosen and begun to develop specific guidelines within these disease areas: anti-platelet therapy for coronary artery disease, glycemic control and prevention of complications in diabetes and hypertension screening for our prevention guideline.
In order to more clearly express the scope of our knowledge modeling exercise, we have also attached several draft disambiguated knowledge specifications we are preparing.
In future years, we plan to develop decision support interventions in other clinical areas.
规则来源: U.S. Preventive Services Task Force recommendation on Aspirin for the Primary Prevention of Cardiovascular Events and the American College of Cardiology’s guideline on Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease.
范围: Patients with diabetes OR coronary artery disease.
总结: Clinicians of patients with either diabetes or coronary artery disease who have indications to be on an anti-platelet but are not currently prescribed an anti-platelet are advised to start either aspirin or clopidogrel.
规则来源: 2007 Diabetes Management Standards of Care from the Clinical Practice Recommendations of the American Diabetes Association, as augmented by Partners HealthCare.
NB: The knowledge specifications for coronary artery disease and hypertension are derived directly from the source guidelines. For diabetes mellitus, we have closely followed the guidelines from the American Diabetes Association, but where there was ambiguity or uncertainty in the guidelines, we have augmented them with the assistance of a local diabetes expert committee under the supervision of Dr. David Nathan, an internationally recognized expert on diabetes management.
范围: Patients with type 2 diabetes
总结: Defines conditions for clinician and patient reminders for hemoglobin A1c checks, ophthalmologic exams, foot exams, and urine protein screening. Defines conditions for advising when to start or adjust diabetic medications, including angiotensin-converting enzymeinhibitors and angiotensin receptor blockers.
规则来源： U.S. Preventive Services Task Force recommendations on Screening for High Blood Pressure
范围: Patients with either diabetes OR coronary artery disease.
总结: Defines conditions for clinician and patient reminders to monitor/record blood pressure measurements and for suggesting referrals to nutrition, cardiac rehab, and hypertension specialists
规则来源: Kupperman, N. et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet: 2009 ;374 1160-1170.
范围: Pediatric patients under the age of 18 with traumatic head injury.
总结: This ruleset makes recommendations as to whether a pediatric head trauma patient is at very low risk for clinically important traumatic brain injury and the utility of imaging, based on history and physical findings.