THIS IS A SHANNON AWARD PROVIDING PARTIAL SUPPORT FOR THE RESEARCH PROJECTS THAT FALL SHORT OF THE ASSIGNED INSTITUTE'S FUNDING RANGE BUT ARE IN THE MARGIN OF EXCELLENCE. THE SHANNON AWARD IS INTENDED TO PROVIDE SUPPORT TO TEST THE FEASIBILITY OF THE APPROACH; DEVELOP FURTHER TESTS AND REFINE RESEARCH TECHNIQUES; PERFORM SECONDARY ANALYSIS OF AVAILABLE DATA SETS; OR CONDUCT DISCRETE PROJECTS THAT CAN DEMONSTRATE THE PI'S RESEARCH CAPABILITIES OR LEAD ADDITIONAL WEIGHT TO AN ALREADY MERITORIOUS APPLICATION. THE APPLICATION BELOW IS TAKEN FROM THE ORIGINAL DOCUMENT SUBMITTED BY THE PRINCIPAL INVESTIGATOR. This proposal describes research intended to support informatics requirements for the development, implementation, and evaluation of clinical practice guidelines. The work is expected to result both in the development of improved guidelines and, concomitantly, to produce structured, computer-accessible repositories of medical knowledge that can be used for decision support. A research program with the following 4 specific aims is proposed: (l) To devise and extend fundamental techniques for modeling and processing guideline knowledge using augmented decision tables. Methods will be defined to deal with guideline knowledge complexity and uncertainty. (2) To refine and disseminate techniques by which knowledge can be acquired for clinical guidelines and verified to assure its consistency and comprehensiveness. Working with the American Academy of Pediatrics, newly developed guidelines will be logically analyzed and verified prior to publication. (3) To evaluate the effectiveness of a guideline-based, decision support device to improve compliance with a national guideline for outpatient management of asthma in children. A randomized, controlled trial will be conducted to measure the effect of the AsthMonitor system on guideline adherence, encounter documentation, patient outcomes, and costs of care. (4) To develop a suite of interactive computer applications that support decision making and clinical workflow for the management of a broad range of common pediatric problems. Knowledge gained from the clinical trial will be combined with workflow analysis, sound application design principles, and advanced digital technologies to create useful and usable tools for guideline implementation. Individual providers will benefit from the availability of decision support applications based on guidelines knowledge. From a public health perspective, effective implementation of evidence-based guidelines for the outpatient management of asthma and other common pediatric disorders should contribute to a reduction in inappropriate practice and to improved quality of care.

Agency
National Institute of Health (NIH)
Institute
National Library of Medicine (NLM)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
1R29LM005552-01A1
Application #
2032350
Study Section
Biomedical Library and Informatics Review Committee (BLR)
Project Start
1997-09-30
Project End
2002-08-31
Budget Start
1997-09-30
Budget End
1998-08-31
Support Year
1
Fiscal Year
1997
Total Cost
Indirect Cost
Name
Yale University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Deshpande, Aniruddha M; Shiffman, Richard N; Nadkarni, Prakash M (2005) Metadata-driven Delphi rating on the Internet. Comput Methods Programs Biomed 77:49-56
Shiffman, Richard N; Dixon, Jane; Brandt, Cynthia et al. (2005) The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Med Inform Decis Mak 5:23
Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb et al. (2004) Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. J Am Med Inform Assoc 11:418-26
Benin, Andrea L; Vitkauskas, Grace; Thornquist, Elizabeth et al. (2003) Improving diagnostic testing and reducing overuse of antibiotics for children with pharyngitis: a useful role for the electronic medical record. Pediatr Infect Dis J 22:1043-7
Agrawal, A; Shiffman, R N (2001) Evaluation of guideline quality using GEM-Q. Medinfo 10:1097-101
Agrawal, A; Shiffman, R N (2001) Using GEM-encoded guidelines to generate medical logic modules. Proc AMIA Symp :7-11
Shiffman, R N; Agrawal, A; Deshpande, A M et al. (2001) An approach to guideline implementation with GEM. Medinfo 10:271-5
Shiffman, R N; Freudigman, M d; Brandt, C A et al. (2000) A guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes. Pediatrics 105:767-73
Karras, B T; Nath, S D; Shiffman, R N (2000) A preliminary evaluation of guideline content mark-up using GEM--an XML guideline elements model. Proc AMIA Symp :413-7
Chen, R S; Shiffman, R N (2000) Assessing growth patterns--routine but sometimes overlooked. Clin Pediatr (Phila) 39:97-102

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