The American Society of Nuclear Cardiology (ASNC) recently named a team of Yale cardiologists winners of the 2023 National Quality Improvement Challenge for their digital clinical decision support tool, Stressing Wisely. This competition builds upon ASNC’s goal of “documenting and providing evidence-based standards” and recognizes interventions that “move the field forward.”
Stressing Wisely is an online decision support tool designed to assist physicians in selecting the most appropriate tests for evaluating cardiovascular disease. The tool uses an intricate matrix of clinical scenarios, harmonizing criteria from various specialty societies into a comprehensive and user-friendly interface. It provides instant feedback on the appropriateness of diagnostic tests, categorizing them into 'appropriate,' 'maybe appropriate,' or 'rarely appropriate.'
The innovative tool was the result of an extensive coding, design, and adjudication effort led by Jiun-Ruey Hu, MD, MPH, clinical fellow (cardiovascular medicine), and Edward Miller, MD, PhD, associate professor (cardiovascular medicine) and director of the Cardiovascular Medicine Fellowship Program, along with a team consisting of cardiovascular medicine fellows Camila Trejo-Paredes, MD, Catherine Wright, MD, Karo Esin, MD; medical student Marah Maayah, and Attila Feher, MD, PhD, assistant professor (cardiovascular medicine).
The motivation to develop the decision support tool sprang from the team noting differences in test use, leading to unnecessary procedures, risks, and costs. This observation sparked the creation of a solution that could significantly improve patient care and reduce unnecessary healthcare expenditures.
Miller’s support and insight were crucial in shaping the direction and success of the project. "When Ruey approached me with this idea, I was impressed by the creativity and scope,” Miller said. “Once I saw the prototype and understood the potential impact, I was fully on board."
The team’s dedication to this project is evident in the meticulous construction of over 2,100 clinical scenarios, involving extensive manual alignment of guidelines from different societies.
“We had to come up with common denominators and fill in the gaps for these remaining scenarios," Hu said, highlighting the complex process that underpins the tool's development.
The success of Stressing Wisely is not just in its technical innovation but also in its potential for widespread clinical application. "Our hope is that this is something that everyone in the country will be able to use," Hu said. “This tool promises to enhance decision-making at the point of care, ensuring that patients receive the most appropriate and evidence-based diagnostic interventions.”
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