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.

项目概要/摘要消除过度使用的健康干预措施是最大限度提高质量和减少浪费的重要一步在美国的医疗保健系统中。急性细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饱和度监测未接受供氧的细支气管炎是一种过度使用的干预措施，尽管有证据表明它对该人群无效并可能造成伤害。现在三项国家指导方针不鼓励对未接受治疗的患有细支气管炎的住院婴儿进行连续脉搏血氧饱和度监测补充氧气。在初步研究中，研究人员表明连续脉搏血氧仪过度使用近一半患有细支气管炎的住院婴儿中没有监测指征，并且过度使用的情况在不同医院之间存在很大差异。申请人的总体目标是确定哪些策略对于消除过度使用的健康干预措施最有效，这些干预措施有可能伤害儿童。此应用程序的总体目标是消除显示器过度使用 (EMO) SpO2 试验，采用纵向整群随机设计的混合 III 型有效性-缺失试验 32 家住院网络医院的儿科研究。该试验将测试一个忘记学习的人取消实施策略（带有审计和反馈的教育外展）与组合取消学习+ 替代取消实施策略（添加电子健康记录集成临床路径）连续脉搏血氧仪监测毛细支气管炎儿童的可持续性没有接受补充氧气。该提案包括三个具体目标：（1）比较关于去实现结果的仅忘却策略与忘却+替代策略，(2) 使用混合方法确定与渗透和可持续性相关的取消实施战略机制， (3) 检查失效对临床结果和意外后果的影响。这该方法具有创新性，因为它侧重于儿科疾病的研究不足的领域，实验设计反映了最先进的取消实施干预的理论框架，以及主要成果侧重于废止的长期可持续性，这与民众。拟议的研究意义重大，因为它将推进医疗保健提供的科学儿童肺部疾病的高发率是急性病毒性细支气管炎，每年有 10 万名儿童住院。这试验还将提供对大规模、严格的过程、机制、成本和结果的新见解。设计的取消实施工作。