UNderstanding the Delivery of Low-Value CAre To CHildren and the Barriers to De-Implementation (UN-LATCH)

了解向儿童提供低价值护理以及取消实施的障碍 (UN-LATCH)

• 批准号: 10649811
• 负责人: Elizabeth Rebecca Wolf
• 金额: $ 7.76万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649811
• 关键词: Academy; Accident and Emergency department; Adverse event; Affect; Age; Agreement; Ambulatory Care; American; Antacids; Antibiotics; Antimicrobial Resistance; Automobile Driving; Awareness; Bronchiolitis; Caring; Characteristics; Child; Child Care; Childhood; Classification; Clinical; Clinical Research; Code; Cognitive; Consolidated Framework for Implementation Research; Data; Database Management Systems; Databases; Deimplementation; Diagnosis; Diagnostic; Education; Family; Family Practice; Feedback; Foundations; Fright; Future; Geographic Distribution; Goals; Grouping; Guidelines; Health Care Costs; Health Knowledge Attitudes Practice; Health Services Research; Healthcare Systems; High Prevalence; Individual; Infant; Inpatients; Insurance; Interview; Knowledge; Measures; Medical Care Costs; Mentorship; Mission; Modeling; Names; National Center for Advancing Translational Sciences; Outcomes Research; Outpatients; Patient-Focused Outcomes; Patients; Pattern; Pediatrics; Pharmaceutical Preparations; Provider; Race; Recommendation; Reflux; Research; Respiratory Tract Infections; Rural; Services; Societies; Structure; Surveys; System; Testing; Translational Research; Translations; Uncertainty; Upper Respiratory Infections; Viral; Virginia; Vitamin D; clinical center; clinical training; cohort; cost; design; evidence base; experience; implementation framework; implementation intervention; implementation research; implementation science; implementation strategy; improved; insight; medical specialties; patient oriented; pediatrician; preference; prevent; programs; rural area; rural residence; rurality; screening; sex; statistics; suburb; systemic barrier; therapy design; urgent care

PROJECT SUMMARY Low-value care, or the provision of care without net benefit, is associated with patient harm and billions of dollars in unnecessary medical costs.18,19 One example is the prescription of antibiotics for viral upper respiratory infections (URIs). It is estimated that over 50% of antibiotic prescriptions for respiratory infections are unnecessary and cost over $700 million per year.20 Antibiotics can increase antimicrobial resistance, and cause adverse events in 10% of patients.21 The Choosing Wisely initiative has been joined by over 80 specialty societies, including the American Academy of Pediatrics, to develop recommendations against low-value care. Despite these recommendations, low-value care continues to affect one in ten children every year.22 To plan for future de-implementation research involving claims-based audit and feedback, we selected three types of pediatric low-value care based on high prevalence22 and the ability to distinguish low-value care using claims data: 1) antibiotics for viral URIs, 2) vitamin D screening in healthy children and 3) antacid medications for infant reflux. It is not well understood to what extent providers are familiar with these recommendations against low- value care. Even if a provider is aware of recommendations against low-value care, there can be other barriers to de-implementation such cognitive biases that favor historical practices, discomfort with diagnostic uncertainty or unease in discussing low-value care with families.23 In Aim 1, we will first evaluate the patient (age, race, sex, insurance type), provider (medical specialty) and system-level factors (clinical setting, healthcare system, rurality) associated with the three different types of low-value care. In Aim 2, we will query providers about 1) knowledge of, 2) agreement with, and 3) actions regarding the three Choosing Wisely recommendations. We will use the Consolidated Framework for Implementation Research (CFIR) framework24-26 to interview a subset of providers about barriers to de-implementation. We will use this information to design a targeted and effective de-implementation strategy that can be used across the Commonwealth of Virginia. This proposal builds on Dr. Wolf's KL2 study related to the delivery of evidence-based, high-value care and her clinical training in general pediatrics. The Center for Clinical and Translational Research (CTSA) will support use of the All-Payers Claims Database (APCD) and mentorship by Drs. Krist and Sabo who have expertise in patient- oriented health services research and implementation science. During the study period, Dr. Wolf will address critical gaps of knowledge about what drives the delivery of low-value care in children and what prevents providers from de-implementing low-value practices. By engaging providers in her research, she will design an intervention that is consistent with their values, preferences, and goals. Ultimately, this proposal will allow Dr. Wolf to build a larger research program to investigate system-oriented, patient-centered solutions to reduce low- value care for children.

项目摘要 低价值护理或无净收益提供护理，与患者伤害和数十亿美元有关 以不必要的医疗费用。18,19一个例子是病毒上呼吸道的抗生素处方 感染（URI）。据估计，超过50％的呼吸道感染抗生素处方是 不必要的每年成本超过7亿美元。20抗生素可以增加抗菌耐药性，并导致 10％的患者中的不良事件。21明智的倡议已与80多种专业一起加入 包括美国儿科学会在内的社会，以针对低价值护理提出建议。 尽管有这些建议，低价值护理每年仍在影响十分之一的孩子。22计划计划 未来涉及基于索赔的审计和反馈的未来降级研究，我们选择了三种类型的 基于高患病率的小儿低价值护理22和使用索赔区分低价值护理的能力 数据：1）病毒uris的抗生素，2）健康儿童的维生素D筛查和3）婴儿的抗酸药物 回流。尚不清楚提供者在多大程度上熟悉这些建议，以针对低 - 价值护理。即使提供商知道针对低价值护理的建议，也可能还有其他障碍 为了消除这种认知偏见，有利于历史实践，对诊断不确定性感到不适 或与家庭讨论低价值护理的不安。23在AIM 1中，我们将首先评估患者（年龄，种族，性别，性别， 保险类型），提供商（医疗专业）和系统级因素（临床环境，医疗保健系统， 乡村）与三种不同类型的低价值护理相关。在AIM 2中，我们将查询大约1） 知识，2）与3）有关这三个选择明智建议的行动。我们 将使用合并框架进行实施研究（CFIR）框架24-26进行采访 提供者关于去实施障碍的提供者。我们将使用此信息设计有针对性的有效 可以在弗吉尼亚州的整个英联邦使用的去实施策略。 该提案是基于沃尔夫博士的KL2研究，与循证，高价值护理的交付有关 一般儿科的临床培训。临床和转化研究中心（CTSA）将支持使用 所有付款人索赔数据库（APCD）和DRS的指导。克里斯特（Krist）和萨博（Sabo）在患者方面具有专业知识 - 定向卫生服务研究与实施科学。在研究期间，沃尔夫博士将解决 关于驱动儿童低价值护理的何种知识的关键差距 提供者脱颖而出的低价值实践。通过让提供者参与她的研究，她将设计一个 与其价值观，偏好和目标一致的干预措施。最终，该建议将允许博士 狼以建立更大的研究计划，以调查以系统为导向的，以患者为中心的解决方案，以减少低 - 儿童的价值护理。