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.
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