De-implementation of inappropriate thyroid ultrasound

取消不适当的甲状腺超声检查

• 批准号: 10665774
• 负责人: Juan P Brito Campana
• 金额: $ 54.19万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-14 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665774
• 关键词: Age; Algorithms; Artificial Intelligence; Automobile Driving; Bankruptcy; Big Data; Caring; Characteristics; Clinical; Clinical Research; Computers; Continuity of Patient Care; County; Data; Data Analyses; Data Set; Databases; Deimplementation; Diagnosis; Disease; Endocrinology; Epidemiology; Ethnic Origin; Evaluation; Financial Hardship; Guidelines; Health; Health system; Healthcare; Healthcare Systems; Incidence; Indolent; Intervention; Interview; Knowledge; Left; Lesion; Machine Learning; Malignant Neoplasms; Malignant neoplasm of thyroid; Maps; Medical; Medical Record Linkage; Methods; Minnesota; Morbidity - disease rate; Natural Language Processing; Newly Diagnosed Disease; Output; Papillary thyroid carcinoma; Participant; Patient Care; Patient Selection; Patients; Personal Satisfaction; Persons; Phenotype; Population; Prevalence; Probability; Procedures; Process; Race; Radiology Specialty; Recommendation; Reproducibility; Research Methodology; Sampling; Site; Structure; Surveys; System; Therapeutic; Thyroid Gland; United States; Validation; Wisconsin; Work; acceptability and feasibility; cancer care; cancer diagnosis; candidate identification; classification algorithm; clinical center; clinical practice; computable phenotypes; cost; data modeling; effectiveness testing; experience; health care delivery; high risk; implementation intervention; implementation research; implementation strategy; improved; medical specialties; mortality; multidisciplinary; overtreatment; patient oriented; phenotyping algorithm; practice factors; prevent; provider factors; psychosocial; rurality; sex; ultrasound

PROJECT SUMMARY/ABSTRACT Inappropriate use of thyroid ultrasound (iTUS) is an important driver of thyroid cancer overdiagnosis and overtreatment, which involves high-risk procedures and long-term therapeutics that cause medical, psychosocial, and financial hardships for patients. Cumulative annual cost of well-differentiated thyroid cancer care in the U.S. has been estimated to exceed $1.5 billion and is projected to reach $3.5 billion by 2030, and the potential cost after 5 years of thyroid cancer diagnosis is $50,000 per patient. Thyroid cancer is one of the fastest-growing cancers in the U.S, but mortality remains very low. Approximately 25% of new cases are attributable to the identification of small thyroid cancers that are unlikely to cause harm if they were left undiagnosed and untreated. The biggest driver of small thyroid cancer diagnosis is iTUS use in asymptomatic people, a practice discouraged by clinical guidelines. The pervasiveness of iTUS despite recommendations against it suggests the need for active strategies to eliminate it. The process of eliminating practices that are not evidence-based is known as de-implementation. To date, no studies have provided a replicable and useful way for health systems to identify their iTUS practices, and there has been no systematic evaluation of multilevel factors driving it, such that we lack key information about targeted, acceptable, and feasible de- implementation strategies. Without them, overuse will persist. To fill this gap, we will leverage a multidisciplinary team with vast experience in computer phenotyping expertise, machine learning, and mixed method research. We will also use two unique databases: the Rochester Epidemiology Project, a medical record-linkage system that captures health care information from the entire population of 27 counties in Minnesota and Wisconsin, and the Patient-Centered Clinical Research Network (PCORnet) that shares a common data model to organize data into a standard structure. There are three aims. Aim 1: Using the REP and two PCORnet sites, to develop a replicable computer phenotype to identify patients receiving iTUS. Aim 2: Using 4 PCORnet sities, to identify patient, clinician, and practice factors associated with iTUS in a representative sample of healthcare practices. Aim 3: Using mixed methods, to understand factors and identify potential strategies for iTUS de-implementation acceptable to the patient, clinician, and health system stakeholders. This proposal is responsive to the objectives of NOT-CA-20-021 to explore de-implementation of ineffective or low-value clinical practices along the cancer care continuum. At the end of this study, we will have developed and validated a computer phenotype to identify iTUS across diverse settings, as well as a list of acceptable strategies likely to decrease iTUS. These findings will be broadly disseminable and will pave the way for studies—deployed in diverse health systems and targeting patients, clincians, and organizations—that test the effectiveness of the de-implementation strategies identified here.

项目摘要/摘要 甲状腺超声（ITU）的不当使用是甲状腺癌过度诊断和 过度治疗，涉及高危程序和导致医学的长期治疗， 心理社会和患者的经济困难。分化良好的甲状腺癌的累积年成本 美国的护理估计超过15亿美元，预计到2030年将达到35亿美元 甲状腺癌诊断5年后的潜在费用为每位患者$ 50,000。甲状腺癌是 在美国增长最快的癌症，但死亡率仍然很低。大约25％的新案例是 归因于鉴定小甲状腺癌，如果留下，这些癌症不太可能造成伤害 未经诊断和未经处理。小甲状腺癌诊断的最大驱动力是无症状的ITU使用 人们，这是一种临床准则劝阻的做法。 ITUS目的地建议的普遍性 反对它表明需要采取积极策略来消除它。消除实践的过程 不是基于证据的人被称为去实施。迄今为止，尚无研究提供可复制且有用的 卫生系统识别其ITU实践的方法，并且没有系统地评估 驱动它的多层次因素，因此我们缺乏有关目标，可接受和可行的de-的关键信息 实施策略。没有它们，过度使用将持续存在。为了填补这一空白，我们将利用 多学科团队在计算机表型专业知识，机器学习和混合方面拥有丰富的经验 方法研究。我们还将使用两个独特的数据库：罗切斯特流行病学项目，医学 记录链接系统，可捕获27个县的整个人口的医疗保健信息 明尼苏达州和威斯康星州，以及以患者为中心的临床研究网络（PCORNET） 通用数据模型将数据组织成标准结构。有三个目标。目标1：使用代表 和两个PCORNET站点，以开发可复制的计算机表型来识别接受ITU的患者。目标2： 使用4个PCORNET站点来识别与ITU相关的患者，临床和实践因素 代表性的医疗保健实践样本。目标3：使用混合方法，了解因素并识别 患者，临床和卫生系统可以接受的ITU下实施的潜在策略 利益相关者。该提案对Not-CA-20-021的目标有反应 沿癌症护理连续体的无效或低价值临床实践。在这项研究结束时，我们将 已经开发并验证了计算机表型，以识别潜水员环境的ITU，以及列表 可接受的策略可能会减少ITU。这些发现将是广泛的，可以铺平 研究的方式 - 在潜水员卫生系统和针对患者，斜语和组织中的剥夺方式 - 测试此处确定的去实施策略的有效性。