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Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project.
Mortier, Philippe; Amigo, Franco; Bhargav, Madhav; Conde, Susana; Ferrer, Montse; Flygare, Oskar; Kizilaslan, Busenur; Latorre Moreno, Laura; Leis, Angela; Mayer, Miguel Angel; Pérez-Sola, Víctor; Portillo-Van Diest, Ana; Ramírez-Anguita, Juan Manuel; Sanz, Ferran; Vilagut, Gemma; Alonso, Jordi; Mehlum, Lars; Arensman, Ella; Bjureberg, Johan; Pastor, Manuel; Qin, Ping.
Afiliação
  • Mortier P; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain. pmortier@researchmar.net.
  • Amigo F; CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain. pmortier@researchmar.net.
  • Bhargav M; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
  • Conde S; CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
  • Ferrer M; School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland.
  • Flygare O; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
  • Kizilaslan B; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
  • Latorre Moreno L; CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
  • Leis A; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
  • Mayer MA; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden.
  • Pérez-Sola V; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Portillo-Van Diest A; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
  • Ramírez-Anguita JM; Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain.
  • Sanz F; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
  • Vilagut G; Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain.
  • Alonso J; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
  • Mehlum L; Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain.
  • Arensman E; CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain.
  • Bjureberg J; Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
  • Pastor M; Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
  • Qin P; CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
BMC Psychiatry ; 24(1): 220, 2024 Mar 20.
Article em En | MEDLINE | ID: mdl-38509500
ABSTRACT

BACKGROUND:

Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored.

METHODS:

PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software.

DISCUSSION:

Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Comportamento Autodestrutivo / Sistemas de Apoio a Decisões Clínicas Limite: Humans Idioma: En Revista: BMC Psychiatry Assunto da revista: PSIQUIATRIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Comportamento Autodestrutivo / Sistemas de Apoio a Decisões Clínicas Limite: Humans Idioma: En Revista: BMC Psychiatry Assunto da revista: PSIQUIATRIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Espanha