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)

基本信息

批准号：
10666514
负责人：
Ruchi S Gupta
金额：
$ 169.8万
依托单位：
LURIE CHILDREN'S HOSPITAL OF CHICAGO
依托单位国家：
美国
项目类别：
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/10666514
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 of Interventions Electronic Health Record Food Food Hypersensitivity Frequencies Goals Guideline Adherence Guidelines Hypersensitivity Incidence Individual Infant Intervention Learning Learning Module Life Measures Methods Morbidity - disease rate National Institute of Allergy and Infectious Disease Outcome Parents Patients Pediatrics Practice Guidelines Prevention Prevention Guidelines Process Provider Publishing Randomized, Controlled Trials Recommendation Reporting Research Risk Risk Assessment Surveys Test Result Testing Translations United States Visit Well Child Visits arm clinical decision support clinical practice cost 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

项目摘要

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.

项目概要和摘要背景：食物过敏 (FA) 是一种可能危及生命的疾病，影响估计 8% 的人在美国的食物过敏儿童中，25% 患有花生过敏 (PA)，这是最主要的过敏症之一。 2017 年，NIAID 发布了致命食物过敏反应的附录指南。美国花生过敏的预防[“花生过敏预防（PPA）指南”]，新的 PPA 指南建议在婴儿期饮食中添加花生产品。儿科医生面临以下直接临床挑战：(a) 评估每个婴儿的 PA 风险，(b) 进行测试或转诊过敏症专家的高危婴儿；以及（c）就如何以及何时添加花生向父母提供建议；而提供符合 PPA 指南的护理具有潜力。为了防止 PA，研究表明 PPA 指南的传播和实施尽管提供者了解这些指南并对其持积极态度，但还是不够充分。具体目标和方法：这个基于实践的集群的主要和次要目标- 随机对照试验旨在确定干预措施的有效性减少儿童早期（花生）过敏 (iREACH)，提高对 PPA 指南的遵守率儿科医生的实践，从而降低了花生过敏的发生率 iREACH，包含 PPA 指南教育模块、4 岁和 6 岁儿童的 EHR 集成 CDS 工具。几个月，并在电子病历中询问家长花生介绍的后续提示儿科医生的依从性将在 6 个月的访问后通过 EHR 数据提取来衡量。过敏发生率将通过调查和电子病历数据提取的家长报告相结合来衡量。其他探索性目标包括：1) 通过 EHR 描述过敏症专家对 PPA 指南的遵守情况拔牙，2) 报告儿科医生遵守 PPA 指南的障碍/促进因素，过敏症专家和家长通过调查，以及 3) 描述家长的依从率（花生产品）通过调查将引入和喂养频率）纳入 PPA 指南。假设和预期结果：我们的主要研究假设是与对照组的婴儿相比 iREACH 干预组中处于高风险和低/中风险的婴儿，将有更高的儿科医生率我们的次要假设是，与高和低/中等相比。与对照组的风险婴儿相比，iREACH 干预组的婴儿花生过敏率较低。对其他研究的意义和影响：这将是第一项系统地检验和影响的研究促进 PPA 指南的实施，该指南有可能大幅减少如果发现 iREACH 有效，则可以快速了解 PA 的发生率及其相关发病率。全国传播并通过实施各种通用电子病历平台。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Development of an innovative curriculum for paediatricians on peanut allergy prevention: How do we address current guidelines?

为儿科医生开发花生过敏预防创新课程：我们如何应对现行指南？

DOI：
10.1111/tct.13689
发表时间：
2024
期刊：
The clinical teacher
影响因子：
0
作者：
Leeds,Stephanie;Slade,Martin;Hafler,Janet;Samady,Waheeda;Jiang,Jialing;Bilaver,Lucy;Gupta,RuchiS
通讯作者：
Gupta,RuchiS

Evaluation of Training to Increase Knowledge of the Addendum Guidelines for the Prevention of Peanut Allergy in the US.