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首页> 美国卫生研究院文献>Journal of Personalized Medicine >Multi-Institutional Implementation of Clinical Decision Support for APOL1 NAT2 and YEATS4 Genotyping in Antihypertensive Management
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Multi-Institutional Implementation of Clinical Decision Support for APOL1 NAT2 and YEATS4 Genotyping in Antihypertensive Management

机译：对抗高血压管理中APOL1NAT2和YEATS4基因分型的多制度实施临床决策支持

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(1) Background: Clinical decision support (CDS) is a vitally important adjunct to the implementation of pharmacogenomic-guided prescribing in clinical practice. A novel CDS was sought for the APOL1, NAT2, and YEATS4 genes to guide optimal selection of antihypertensive medications among the African American population cared for at multiple participating institutions in a clinical trial. (2) Methods: The CDS committee, made up of clinical content and CDS experts, developed a framework and contributed to the creation of the CDS using the following guiding principles: 1. medical algorithm consensus; 2. actionability; 3. context-sensitive triggers; 4. workflow integration; 5. feasibility; 6. interpretability; 7. portability; and 8. discrete reporting of lab results. (3) Results: Utilizing the principle of discrete patient laboratory and vital information, a novel CDS for APOL1, NAT2, and YEATS4 was created for use in a multi-institutional trial based on a medical algorithm consensus. The alerts are actionable and easily interpretable, clearly displaying the purpose and recommendations with pertinent laboratory results, vitals and links to ordersets with suggested antihypertensive dosages. Alerts were either triggered immediately once a provider starts to order relevant antihypertensive agents or strategically placed in workflow-appropriate general CDS sections in the electronic health record (EHR). Detailed implementation instructions were shared across institutions to achieve maximum portability. (4) Conclusions: Using sound principles, the created genetic algorithms were applied across multiple institutions. The framework outlined in this study should apply to other disease-gene and pharmacogenomic projects employing CDS.
机译：（1）背景：临床决策支持（CDS）是在临床实践药物基因组学制导规定执行情况的非常重要的辅助手段。一种新的CDS被追捧为APOL1，NAT2和YEATS4基因，以指导临床试验在多个参与机构照顾非洲裔人口中的抗高血压药物的最佳选择。 （2）方法：CDS委员会，临床内容和CDS专家组成，制定了一个框架，并有助于创造使用以下指导原则CDS的：1.医疗算法共识; 2.诉; 3.上下文敏感触发; 4.工作流程的整合; 5.可行性; 6.解释性; 7.可移植性;和8实验室结果的离散报告。 （3）结果：利用离散患者的实验室和重要的信息的原则，为APOL1，NAT2和YEATS4一种新颖的CDS是为在基于医疗算法共识一个多机构试用创建。该警报是可行的和容易解释，明确显示的目的和建议相关实验室结果，生命体征和链接与建议降压剂量ordersets。快讯要么立即触发一次提供商开始顺序有关降压药或战略地位的工作流程相适应的一般CDS部分的电子健康记录（EHR）。详细的实施说明了跨机构共享，以实现最大的可移植性。 （4）结论：使用合理的原则，所创建的遗传算法进行跨越多个机构施加。在这项研究中概述的框架应适用于其他疾病的基因和使用CDS药物基因组学项目。

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