Eliminating Monitor Overuse (EMO) Hybrid Effectiveness-Deimplementation Trial

消除显示器过度使用 (EMO) 混合有效性-取消实施试验

基本信息

批准号：
10315079
负责人：
Rinad Sary Beidas
金额：
$ 72.32万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10315079
关键词：
Academy Acute Address Admission activity Air American Area Bronchiolitis Caring Categories Child Childhood Clinical Clinical Pathways Clinical Research Deimplementation Disease Education Effectiveness Electronic Health Record Experimental Designs Fatigue Feedback Fostering Funding Goals Guidelines Health Health Sciences Healthcare Healthcare Systems Hospital Charges Hospitalization Hospitals Hybrids Incidence Infant Infectious Lung Disorder Inpatients Intervention Interview Length of Stay Link Lung diseases Measurement Medical Methods Monitor National Heart, Lung, and Blood Institute Observational Study Outcome Oxygen Pathway interactions Patient Monitoring Patient-Focused Outcomes Patients Pediatric Research Pediatrics Penetration Phase Population Process Public Health Pulse Oximetry Randomized Research Research Personnel Risk Science System Testing United States United States National Institutes of Health Viral Bronchiolitis Viral Respiratory Tract Infection Vision acute bronchiolitis arm base cost cost outcomes design health care delivery implementation research improved innovation insight outreach patient safety pilot trial primary outcome secondary outcome success supplemental oxygen wasting

项目摘要

PROJECT SUMMARY/ABSTRACT Deimplementing overused health interventions is an essential step in maximizing quality and minimizing waste in the United States health care system. Acute bronchiolitis is a common lung disease of young children caused by respiratory viral infection. Continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen is an overused intervention that has persisted despite evidence that it is ineffective in this population and may cause harm. Three national guidelines now discourage continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. In preliminary studies, the investigators showed that continuous pulse oximetry overuse occurs in nearly half of all hospitalized infants with bronchiolitis for whom there is no monitoring indication, and there is high between-hospital variability in overuse. The overarching goal of the applicants is to determine which strategies are most effective for deimplementing overused health interventions that have the potential to harm children. The overall objective of this application is to conduct the Eliminating Monitor Overuse (EMO) SpO2 trial, a hybrid type III effectiveness-deimplementation trial with a longitudinal cluster-randomized design in 32 Pediatric Research in Inpatient Settings Network hospitals. The trial will test an unlearning deimplementation strategy (educational outreach with audit & feedback) vs. a combined unlearning + substitution deimplementation strategy (adding an electronic health record-integrated clinical pathway) on sustainability of continuous pulse oximetry monitoring deimplementation in children with bronchiolitis who are not receiving supplemental oxygen. This proposal includes three Specific Aims: (1) Compare the effects of the unlearning only strategy versus the unlearning + substitution strategy on deimplementation outcomes, (2) Identify deimplementation strategy mechanisms linked to penetration and sustainability using mixed methods, and (3) Examine the effects of deimplementation on clinical outcomes and unintended consequences. This approach is innovative because it focuses on the under-researched area of pediatric deimplementation, the experimental design reflects state-of-the-art theoretical framing of deimplementation interventions, and the primary outcome focuses on long-term sustainability of deimplementation, which is highly relevant to the public. The proposed research is significant because it will advance the science of health care delivery for a high incidence pediatric lung disease that hospitalizes 100,000 children annually, acute viral bronchiolitis. The trial will also provide new insights into the processes, mechanisms, costs, and outcomes of large, rigorously- designed deimplementation efforts.

项目摘要/摘要降级过度使用的健康干预措施是最大化质量和最小化废物的重要步骤在美国医疗保健系统中。急性支气管炎是幼儿常见的肺部疾病由呼吸道病毒感染引起。住院婴儿的连续脉搏血氧仪监测不接受补充氧的支气管炎是一种过度使用的干预措施，尽管证据表明它在该人群中无效并可能造成伤害。现在三个国家准则不鼓励未接受的细支气管炎的住院婴儿的连续脉搏血氧饱和度监测补充氧气。在初步研究中，研究人员表明连续的脉搏血氧仪过度使用在所有没有监测指示的细支气管炎的住院婴儿中，几乎一半发生过度使用的院间变异性很高。申请人的总体目标是确定哪些策略最有效地降级过度使用的健康干预措施，这些干预措施有可能伤害儿童。该应用的总体目的是进行消除监视器过度使用（EMO） SPO2试验，一项混合III型有效性 - 实施试验，具有纵向群集的设计在住院环境医院的32个小儿研究中。审判将测试一个未学习的衰落策略（与审计和反馈的教育宣传）与联合学习 + 在连续脉搏血氧饱和度监测的可持续性是细支气管炎儿童未接受补充氧气。该建议包括三个具体目的：（1）比较仅在降级结果上使用策略与未学习 +替换策略，（2）确定使用混合方法与渗透和可持续性相关的衰减策略机制，（3）检查降级对临床结果和意外后果的影响。这方法是创新的，因为它专注于小儿降解的研究不足的领域，实验设计反映了衰减干预措施的最新理论框架，主要结果的重点是降级的长期可持续性，这与民众。拟议的研究很重要，因为它将推进医疗保健科学的能力高发儿科肺部疾病每年住院的100,000名儿童，急性病毒触支疾病。这试验还将为大型，严格的过程，机制，成本和结果提供新的见解。设计了降级工作。