Intervention to Reduce Early (Peanut) Allergy in Children (iREACH)

减少儿童早期（花生）过敏的干预措施 (iREACH)

• 批准号: 10212208
• 负责人: Ruchi S Gupta
• 金额: $ 144.51万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-24 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10212208
• 关键词: Academy; Addendum; Address; Adherence; Affect; Age; Allergic; Allergic Reaction; Allergy to eggs; Allergy to peanuts; American; Caring; Child; Childhood; Clinical; Clinical Decision Support Systems; Clinical Practice Guideline; Community Networks; Community Practice; Complex; Counseling; Data; Diagnosis; Diet; Dissemination and Implementation; Eczema; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Food; Food Hypersensitivity; Frequencies; Goals; Guideline Adherence; Guidelines; Incidence; Individual; Infant; Intervention; Learning; Learning Module; Life; Measures; Methods; Morbidity - disease rate; National Institute of Allergy and Infectious Disease; Outcome; Parents; Patients; Practice Guidelines; Prevention; Prevention Guidelines; Process; Provider; Publishing; Randomized Controlled Trials; Recommendation; Reporting; Research; Risk; Risk Assessment; Risk Reduction; Surveys; Test Result; Testing; Time; Translations; United States; Visit; Well Child Visits; arm; base; clinical decision support; clinical practice; design; dietary; early childhood; effectiveness evaluation; expectation; feeding; follow-up; high risk; high risk infant; improved; infancy; insight; novel; novel strategies; pediatrician; practice setting; prevent; provider adherence; support tools; treatment arm

PROJECT SUMMARY AND ABSTRACT Background: Food allergy (FA) is a potentially life-threatening condition that affects an estimated 8% of children in the United States. Among food-allergic children, 25% have a peanut allergy (PA), one of the leading causes of fatal food-allergic reactions. In 2017, the NIAID published the Addendum Guidelines for the Prevention of Peanut Allergy in the United States [“Prevention of Peanut Allergy (PPA) Guidelines”], recommending dietary introduction of peanut products during infancy. The new PPA Guidelines present the following immediate clinical challenges for pediatricians: (a) to assess each infant's PA risk, (b) to test or refer high-risk infants to allergists; and (c) to counsel parents regarding how and when to incorporate peanut- containing products into an infant's diet. While the provision of PPA Guideline-consistent care has the potential to prevent PA, research has shown that dissemination and implementation of the PPA Guidelines has been inadequate, even though providers are knowledgeable about the guidelines and view them favorably. Specific Aims and Methods: The primary and secondary aims of this practice-based cluster- randomized controlled trial are to determine the effectiveness of an Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) in increasing adherence to PPA Guideline practices among pediatricians and subsequently decreasing the incidence of peanut allergy in children. iREACH, incorporates a PPA Guideline education module, an EHR-integrated CDS tool at 4- and 6- months, and follow-up prompts within the EHR inquiring about parental peanut introduction practices. Pediatrician adherence will be measured through EHR data extraction after the 6-month visit. Peanut allergy incidence will be measured through a combination of parent-report via survey and EHR data extraction. Other exploratory objectives include: 1) Describing allergist adherence to the PPA Guidelines via EHR extraction, 2) Reporting barriers/facilitators for PPA Guideline adherence among pediatricians, allergists and parents via surveys, and 3) Describing rates of parental adherence (peanut product introduction and feeding frequency) to the PPA Guidelines via survey. Hypotheses and Expected Results: Our primary study hypothesis is that compared with infants in the control arm infants at high and low/moderate risk in the iREACH intervention arm, will have higher rates of pediatrician adherence to the PPA Guidelines. Our secondary hypothesis is that when compared to high and low/moderate risk infants in the control arm, those in the iREACH intervention arm will have lower rates of peanut allergy. Significance and Effects on Other Research: This will be the first study to systematically examine and promote the implementation of the PPA Guidelines, which have the potential to dramatically reduce the incidence of PA and its associated morbidity in the US. If found to be effective, iREACH is designed for swift national dissemination and implementation via a variety of common EHR platforms.

项目摘要和摘要 背景：食物过敏（FA）是一种潜在的威胁生命的疾病，估计有8％ 美国的孩子。在食品过敏儿童中，有25％的花生过敏（PA）是领先的 致命的食物过敏反应的原因。 NIAID在2017年发布了《附录指南》 美国预防花生过敏[“预防花生过敏（PPA）指南”]， 建议在婴儿期饮食中引入钢琴产品。新的PPA指南提出了 在针对儿科医生面临临床挑战之后：（a）评估每个婴儿的PA风险，（b）测试或参考 过敏者的高风险婴儿； （c）向父母咨询如何以及何时纳入花生 将产品纳入婴儿的饮食中。虽然提供PPA指南一致的护理具有潜力 为了防止PA，研究表明，PPA指南的传播和实施已有 不足，即使提供者对准则有了了解并有利地看待这些准则。 具体目的和方法：此基于实践的集群的主要和次要目标 - 随机对照试验是确定干预的有效性 减少儿童（iREACH）的早期（花生）过敏，以增加遵守PPA指南 儿科医生的做法，随后减少了花生过敏事件 孩子们。 IREACH，合并了PPA指南教育模块，这是4个和6--的EHR集成的CDS工具 几个月，以及EHR中的后续提示，询问父母花生介绍 实践。访问6个月后，将通过EHR数据提取来测量儿科医生的依从性。花生 过敏事件将通过通过调查和EHR数据提取的父母报告组合来衡量。 其他探索对象包括：1）通过EHR描述对PPA指南的过敏症主的遵守 提取，2）报告儿科医生遵守PPA指南的障碍/促进者， 过敏症分子和父母通过调查以及3）描述父母依从性的率（花生产品 引入和进食频率）通过调查到PPA指南。 假设和预期结果：我们的主要研究假设是与对照中的婴儿相比 IREACH干预组中高和低/中等风险的臂婴儿的儿科医生的速率更高 遵守PPA指南。我们的次要假设是，与高/低/中等相比 控制臂中的风险婴儿，IREACH干预臂中的那些花生过敏率较低。 对其他研究的意义和影响：这将是系统检查和 促进PPA指南的实施，该准则有可能大大减少 PA的发病率及其在美国相关的发病率。如果发现有效，IREACH是为Swift设计的 通过各种常见的EHR平台进行国家传播和实施。