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Press Release Date: December 18, 1996
New research efforts announced today by the Agency for Health
Care Policy and Research (AHCPR) are designed to explore the
benefits of using computerized decision-support systems in
everyday clinical practice.
"These projects will take medical decisionmaking computer
software programs out of the laboratory and put them into primary
care networks," said Clifton R. Gaus, Sc.D., AHCPR administrator.
"The studies are designed to ascertain whether everyday use of
these systems can improve health care quality, efficiency and
effectiveness at a reduced cost." Dr. Gaus said that each project
will focus on a clinical area where the appropriate diagnosis and
management of illnesses is less than ideal.
This research is a component of AHCPR's participation, as one of
12 member agencies, in the High Performance Computing and
Communications Program of the United States (HPCC) and in the
National Information Infrastructure (NII), an initiative of
President Clinton and Vice President Gore. HPCC and NII promote
increased speed and capacity of computers and electronic
networks, as well as make the transmission and storage of data
AHCPR aims to link HPCC technology to community health needs,
specifically in the areas of computer-based patient records,
computerized decision-support systems and telemedicine. With its
research in these areas, AHCPR is evaluating promising
technologies for measuring outcomes, access and cost impacts of
health care, and for delivering improved quality of care.
"As part of the HPCC and NII efforts, the new projects will build
upon AHCPR's research experience with computer-based patient
record systems and telemedicine," said J. Michael Fitzmaurice,
Ph.D., director of AHCPR's Center for Information Technology.
The studies use networks such as the Internet as vehicles for
extending the use of these computer systems beyond academic
medical centers and into the offices of primary care physicians.
"The result of this research should lead to increased awareness
of computer technology that will ultimately enhance information
sharing among health care providers and practitioners," said Dr.
AHCPR will spend a total of $4.55 million to support the studies
over a three-year period.
The studies are:
Computerized Decision Support for Post-Transplant
Care. (Grant No.: HS09407) Principal investigator: Keith M.
Sullivan, M.D., Fred Hutchinson Cancer Research Center,
Seattle, Wash. 1996-1999. Total estimated funding: $1.51
Will look at improving primary care physicians'
manage post-discharge bone marrow transplantation patients
by developing, implementing and evaluating a World Wide Web-based
computerized decision-support system. The intent is to
facilitate information exchange and guide interactions among
physicians in different locations and centrally located
experts in bone marrow transplantation.
Family Linkages Supporting Hyperbilirubin
Guidelines. (Grant No.: HS09390) Principal investigator: Charles J.
Homer, M.D., Children's Hospital, Boston, Mass. 1996-1999.
Total estimated funding: $726,589.
Will address the problem of hyperbilirubinemia in
developing and implementing a computer-based decision-support
system. This system will help providers identify and
treat infants at risk for developing significant medical
problems associated with hyperbilirubinemia by providing
better access to patient records and guidelines. Although
most infants develop transient, unconjugated
hyperbilirubinemia between the second and fifth day of life,
the elevation of bilirubin is usually self-limited since
liver enzyme activity normally picks up within a few days.
The issue is how to detect and treat cases that are not
Depression Care Using Computerized Decision Support. (Grant
No.: HS09421) Principal investigator: Bruce L. Rollman,
M.D., University of Pittsburgh, Pittsburgh, Pa. 1996-1999.
Total estimated funding: $644,409.
Will develop and implement a computerized decision-support
system that prompts primary care physicians to implement
treatment recommendations based upon the AHCPR-sponsored
practice guideline on depression in primary care. Following
this, the researchers will conduct a randomized clinical
trial to examine the clinical outcomes and costs of
providing care this way, and will evaluate the effects on
physicians' practices, knowledge and attitudes of
disseminating the depression guideline by computer.
Evaluating Computer Decision Support for Preventive
Care. (Grant No.: HS09507) Principal investigator: Stephen M.
Downs, M.D., University of North Carolina, Chapel Hill, N.C.
1996-1999. Total estimated funding: $878,855.
Will expand and modify for everyday use in pediatric
practices an existing guideline-based computerized decision
service for childhood preventive services. The study will
evaluate the effects of the system on process of care and
outcomes of patients in private pediatric practice.
Interactive, Guideline-Based Decision Support on the
Web. (Grant No.: HS09436) Principal investigator: David F.
Lobach, M.D., Ph.D., Duke University Medical Center, Durham,
N.C. 1996-1999. Total estimated funding: $785,343.
Will study the increased use of guideline
automating clinicians' access to a decision-support system
that makes relevant guidelines available at the point of
care through an interface with electronic medical record
systems. This study will create a clinical decision-support
system that uses a World Wide Web-based guideline server.
The server is directly accessible from electronic medical
records systems and protects patient confidentiality.
In addition, AHCPR has funded one other study on computerized
decision support through an interagency agreement with the
National Library of Medicine. The study, "Computerized
Decision-Support Deployment in Diverse Clinical Settings," will
be led by Michael G. Kahn, M.D., Ph.D., Barnes Jewish Hospital,
St. Louis, Mo. In this study, researchers will implement and
evaluate two computerized drug monitoring
systems—DoseChecker and ADE
Monitor—and design and implement a drug alert notification
subsystem in different clinical settings within the Washington
University and Barnes Jewish Hospital health system. The alert
notification subsystem will be evaluated for differences in
expert system performance, physician acceptance and clinical
The Agency for Health Care Policy and Research, a part of the
Department of Health and Human Services, is the lead agency
charged with supporting research designed to improve the quality
of health care, reduce its cost and enhance access to essential
services. AHCPR's broad programs of research and technology
assessment bring practical, science-based information to medical
practitioners, and to consumers and other health care purchasers.
For additional information, contact AHCPR Public Affairs: Howard Holland, (301) 427-1857; Salina Prasad, (301) 427-1864.