Development of a serious game to measure physician implementation of trauma triage guidelines

开发一款严肃的游戏来衡量医生对创伤分类指南的执行情况

• 批准号: 10646651
• 负责人: Deepika Mohan
• 金额: $ 27.32万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10646651
• 关键词: Address; Adherence; Assessment tool; Behavior; Behavior assessment; Behavioral; Budgets; Calibration; Clinical; Clinical Practice Guideline; Development; Effectiveness; Elderly; Emergency Department Physician; Emergency department visit; Equilibrium; Fostering; Future; Guidelines; Hospitalization; Incidence; Injury; Intervention; Interview; Laboratories; Licensing; Measurement; Measures; Methods; Outcome; Pain; Paper; Patient Triage; Patient-Focused Outcomes; Patients; Performance; Physicians; Play; Process; Property; Quality of life; Radar; Research; Resources; Respondent; Sampling; Signal Detection Analysis; Source; Structure; Surveys; Testing; Time; Trauma; Trauma patient; Triage; Uncertainty; Variant; Video Games; Work; World War II; adverse outcome; behavior change; behavioral phenotyping; burnout; care costs; clinical implementation; cognitive load; contextual factors; cost; effective intervention; game development; human old age (65+); implementation strategy; improved; injured; mortality; multidisciplinary; non-compliance; novel; older patient; personalized approach; pressure; preventable death; programs; prototype; provider behavior; recruit; severe injury; social norm; tool; trauma centers; user centered design; virtual reality simulation; wasting

ABSTRACT Injury is the leading cause of loss of independence among those over the age 65, resulting in over 3 million Emergency Department (ED) visits, 800,000 hospitalizations, and greater than $50 billion in costs each year. Guideline-concordant triage of trauma patients – rapid identification of those with severe injuries and transfer to trauma centers – decreases mortality by 10 to 25%, reduces loss of independence, and diminishes pain at one year. Despite this evidence, under-triage persists (incidence: 50%), particularly among those over the age of 65 (incidence: 80%). Causes of non-compliance with clinical practice guidelines varies among physicians. Moreover, exposing physicians to inappropriate interventions can have serious unintended consequences. To address the implementation gap, we therefore propose to develop a novel serious game (an applied video game) to measure physician behavior in trauma triage and to identify sources of non-compliance. In Aim 1, we will build the game using an established, user-centered design process that involves formative research with stakeholders (n=20), prototype development, and then calibration through iterative play-testing with a national convenience sample of physicians (n=30). In Aim 2, we will establish the initial measurement properties of the game by recruiting a local convenience sample of physicians (n=100), auditing their charts, and conducting semi-structured interviews so that we can assess internal consistency reliability, re-test reliability, criterion validity, and convergent construct validity. This proposal will deliver a tool that can be used to inform the selection of interventions in future efforts to increase the implementation of guidelines in trauma triage, and thereby to improve patient outcomes after injury.

抽象的 伤害是65岁以上的人失去独立性的主要原因，导致超过300万 急诊科（ED）访问，80万住院和每年超过500亿美元的费用。 创伤患者的指南符合分类 - 快速识别患有严重伤害并转移到的人 创伤中心 - 将死亡率下降10％至25％，减少独立性的丧失，并减轻疼痛。 年。尽管有证据表明，较低的人仍然存在（发病率：50％），尤其是在年龄以上的人中 65（发病率：80％）。与临床实践指南不合规的原因不同。 此外，让医生接受不当干预措施可能会带来严重的意外后果。到 解决实现差距，因此我们建议开发一个新颖的认真游戏（应用的视频 游戏）以衡量创伤分类中的身体行为并确定不合规的来源。在AIM 1中，我们 将使用既定，以用户为中心的设计过程来构建游戏，该过程涉及与形成性研究 利益相关者（n = 20），原型开发，然后通过迭代游戏进行校准 医生的便利样本（n = 30）。在AIM 2中，我们将建立最初的测量属性 通过招募当地的医生便利样本（n = 100），审核他们的图表并进行进行游戏 半结构化访谈，以便我们可以评估内部一致性可靠性，重新测试可靠性，标准 有效性和收敛构建有效性。该提案将提供一个可以用于告知该工具的工具 在未来的努力中选择干预措施，以增加创伤分类指南的实施，并 从而改善受伤后的患者预后。