开发和整合机器学习算法来识别外围动脉疾病:多利益相关者定性研究
Sabrina M Wang1, H D Jeffry Hogg2,3, Devdutta Sangvai4
1Duke University School of Medicine, Durham, NC, United States.
JMIR formative research
|September 21, 2023
概括
整合机器学习 (ML) 驱动的临床决策支持 (CDS) 用于外围动脉疾病 (PAD) 识别需要非技术因素,如领导和用户需求. 解决组织和公平挑战对于现实世界的成功至关重要.
科学领域:
- 医疗保健信息学 医疗保健信息学
- 人工智能在医学中的应用
- 临床决策支持系统 临床决策支持系统
背景情况:
- 机器学习 (ML) 驱动的临床决策支持 (CDS) 显示出改善医疗保健质量的承诺,但面临实施挑战.
- 基于ML驱动的CDS集成的现实结果是混合的,需要对影响因素进行进一步的调查.
研究的目的:
- 探索影响外围动脉疾病 (PAD) 识别算法的整合到临床工作流程中的因素.
- 了解如何实施及时,基于指南的护理,使用ML驱动的CDS用于PAD.
主要方法:
- 在ML驱动的CDS集成过程中,与技术,管理和临床利益相关者进行了12次半结构面试.
- 应用主题分析到伪名化成绩单,以确定与整合相关的关键主题.
- 专注于基于ML的CDS,以识别高概率PAD病例进行跨学科审查和初级保健提供者的建议.
主要成果:
- 成功将ML算法性能转化为现实世界的有效性取决于非技术因素:强大的临床领导力,可信的工作流程,最终用户关注度和可操作的问题识别.
- 整合的挑战包括缺乏语境整合,缺少反循环和数据孤岛.
- 确定了利益相关者特定的成功标准,突出了在CDS整合中的不同需求和团队动态.
结论:
- 纵向,多学科的利益相关者参与对于有效的ML驱动的CDS转化为现实世界护理至关重要.
- 除了技术方面之外,包括行政/运营领导者以及早期考虑临床医生的需求至关重要.
- 整体观点揭示了由ML驱动的CDS加剧的健康不平等;解决方案通常需要系统的,非ML干预措施来缓解PAD护理中的差异.
相关概念视频
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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01:30Peripheral Artery Disease I: Introduction
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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs but also impacts other areas, such as the arms, thereby impairing overall circulation and organ function.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty deposits inside the arterial...
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01:27Peripheral Artery Disease III: Interprofessional Care
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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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01:26Peripheral Artery Disease IV: Nursing Management
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The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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01:10Pre-Procedural Guidelines for Assessing Blood Pressure
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Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the...
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