Cole-Lewis Heather J, Smaldone Arlene M, Davidson Patricia R, Kukafka Rita, Tobin Jonathan N, Cassells Andrea, Mynatt Elizabeth D, Hripcsak George, Mamykina Lena
Department of Biomedical Informatics, Columbia University, New York, NY, USA; ICF International, Rockville, MD, USA.
School of Nursing, Columbia University, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.
Int J Med Inform. 2016 Jan;85(1):96-103. doi: 10.1016/j.ijmedinf.2015.08.003. Epub 2015 Aug 8.
To develop an expandable knowledge base of reusable knowledge related to self-management of diabetes that can be used as a foundation for patient-centric decision support tools.
The structure and components of the knowledge base were created in participatory design with academic diabetes educators using knowledge acquisition methods. The knowledge base was validated using scenario-based approach with practicing diabetes educators and individuals with diabetes recruited from Community Health Centers (CHCs) serving economically disadvantaged communities and ethnic minorities in New York.
The knowledge base includes eight glycemic control problems, over 150 behaviors known to contribute to these problems coupled with contextual explanations, and over 200 specific action-oriented self-management goals for correcting problematic behaviors, with corresponding motivational messages. The validation of the knowledge base suggested high level of completeness and accuracy, and identified improvements in cultural appropriateness. These were addressed in new iterations of the knowledge base.
The resulting knowledge base is theoretically grounded, incorporates practical and evidence-based knowledge used by diabetes educators in practice settings, and allows for personally meaningful choices by individuals with diabetes. Participatory design approach helped researchers to capture implicit knowledge of practicing diabetes educators and make it explicit and reusable.
The knowledge base proposed here is an important step towards development of new generation patient-centric decision support tools for facilitating chronic disease self-management. While this knowledge base specifically targets diabetes, its overall structure and composition can be generalized to other chronic conditions.
开发一个可扩展的知识库，其中包含与糖尿病自我管理相关的可重复使用知识，可作为以患者为中心的决策支持工具的基础。
知识库的结构和组成部分是通过与学术糖尿病教育工作者采用知识获取方法进行参与式设计创建的。使用基于场景的方法对知识库进行验证，参与验证的人员包括执业糖尿病教育工作者以及从纽约为经济弱势社区和少数民族服务的社区健康中心招募的糖尿病患者。
该知识库包括八个血糖控制问题、150多种已知会导致这些问题的行为及其背景解释，以及200多个针对纠正问题行为的具体行动导向型自我管理目标，并配有相应的激励信息。知识库的验证表明其具有高度的完整性和准确性，并确定了在文化适宜性方面的改进方向。这些在知识库的新迭代中得到了处理。
所得知识库具有理论基础，纳入了糖尿病教育工作者在实践中使用的实用和循证知识，并允许糖尿病患者做出具有个人意义的选择。参与式设计方法帮助研究人员获取了执业糖尿病教育工作者的隐性知识，并使其明确且可重复使用。
本文提出的知识库是朝着开发新一代以患者为中心的决策支持工具以促进慢性病自我管理迈出的重要一步。虽然这个知识库专门针对糖尿病，但它的整体结构和组成可以推广到其他慢性病。
