De-Implementation of Low Value Imaging in Pulmonary Embolism (DELVE PE)

肺栓塞低价值成像的取消实施 (DELVE PE)

基本信息

批准号：
10685285
负责人：
Lauren Westafer
金额：
$ 17.46万
依托单位：
BAYSTATE MEDICAL CENTER, INC.
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10685285
关键词：
Accident and Emergency department Address Administrator Advisory Committees Algorithms American American College of Physicians American College of Radiology Anaphylaxis Angiography Area Behavior Belief Benchmarking Caring Chest Clinical Communities Data Deimplementation Development Plans Diagnosis Dimensions Dyes Education Effectiveness Electronic Health Record Elements Emergency Department Physician Emergency Medicine Emergency department visit Emotions Ensure Evaluation Evidence based practice Feedback Fright Goals Guidelines Health system Image Informatics Institution Intervention Interview Investigation Ionizing radiation K-Series Research Career Programs Knowledge Learning Module Lung Massachusetts Mentored Clinical Scientist Development Program Mentored Patient-Oriented Research Career Development Award Mentors Methodology Methods Multicenter Trials National Heart, Lung, and Blood Institute Patient Care Patients Peer Pressure Performance Physicians Pilot Projects Positioning Attribute Provider Pulmonary Embolism Recommendation Reporting Research Research Personnel Risk Safety Societies Structure Surveys Technical Expertise Testing Training United States Work X-Ray Computed Tomography behavior change career development clinical decision support cognitive testing college cost design empowerment evidence base experience imaging study implementation barriers implementation facilitators implementation framework implementation science implementation strategy improved innovation insight lung imaging novel organizational climate overtreatment podcast practice setting prototype provider behavior risk stratification social influence success theories tomography tool trial design usability user centered design

项目摘要

1 PROJECT SUMMARY 2 Two percent (2%) of all 120 million annual emergency department (ED) visits in the United States undergo computed 3 tomographic pulmonary angiography (CTPA) for pulmonary embolism (PE) every year. However, many of these are 4 avoidable. Unnecessary testing subjects patients to additional costs, ionizing radiation, and risk of anaphylaxis from contrast 5 media. Further, because false positive CTPAs are common (estimated at 5-26%), overdiagnosis and overtreatment are 6 growing problems in the United States. Despite guidelines recommending the reduction of low-value imaging for PE, the 7 volume of unnecessary imaging studies for PE in US EDs continues to rise, exposing patients to harm from overtesting and 8 overdiagnosis. Prior strategies have attempted to close this knowledge-practice quality gap but only had modest success, 9 possibly because changing provider behavior is challenging and most initiatives focused on isolated strategies. We propose 10 to develop, pilot, and evaluate a multi-dimensional `enhanced' audit-feedback strategy (EAF) to de-implement low-value 11 imaging in PE. The core strategy, audit-feedback, was chosen to target drivers of low-value imaging in PE discovered in 12 our foundational work: knowledge, peer pressure, emotion, and belief about consequences. We designed the strategy using 13 a novel audit-feedback theory, the Clinical Performance Feedback Intervention Theory (CP-FIT). The audit-feedback is 14 `enhanced' by complementary strategies to assist in action planning and empower clinicians to change their behavior. This 15 includes an aid for appropriate testing that guides clinicians through an unambiguous algorithm for evaluation of PE, an 16 educational podcast, and local champions. In Aim 1, we will develop, refine, and operationalize the de-implementation 17 strategy components. We will conduct cognitive testing of the prototypes of the audit-feedback reports, develop an 18 electronic health record (EHR)-integrated aid, record the educational podcast, and identify and train local champions. In 19 Aim 2, we will pilot alternative versions of the EAF strategy in 5 EDs to evaluate acceptability and appropriateness. We 20 will alter the delivery of the components of feedback (local champion versus departmental chair), educational podcast (with 21 or without a real patient narrative), and the aid for appropriate testing (static versus EHR-integrated aid) to ascertain the 22 acceptability, appropriateness, and added value of these iterations. We will pilot different versions of the strategy to evaluate 23 aspects of CP-FIT including complexity, social influence, and actionability, which CP-FIT suggests drive the audit-feedback 24 cycle and, ultimately, behavior change. We will use mixed methods to evaluate the strategy and select a refined strategy for 25 a multi-center trial. In this K23 application, we have proposed a detailed career development plan in which I will gain 26 methodological and technical expertise in advanced implementation science strategies, methods, and trial design. I am well 27 supported by an experienced team of mentors and advisors. At the end of this mentored career development award, I will 28 have a robust empirically-derived and theory-informed strategy and will be positioned to test this strategy in a multi-center 29 trial as an independent investigator. 30

1个项目摘要 2％（2％）在美国的1.2亿年急诊室（ED）访问中进行了计算 3每年用于肺栓塞（PE）的肺部肺动脉血管造影（CTPA）。但是，其中许多是 4可以避免。不必要的测试受试者患者承担额外成本，电离辐射以及对比度过敏反应的风险 5个媒体。此外，由于假阳性CTPA是常见的（估计为5-26％），因此过度诊断和过度治疗是 6美国日益增长的问题。尽管指南建议减少PE的低价值成像，但 7美国ED中PE的不必要的成像研究持续上升，暴露于患者中受到过度损害和 8过度诊断。先前的策略试图缩小这一知识质量差距，但仅取得了不大的成功， 9可能是因为不断变化的提供商的行为具有挑战性，大多数倡议都集中在孤立的策略上。我们建议 10开发，试行和评估多维“增强”审计反馈策略（EAF）以消除低估的低价值 11成像中的成像。选择核心策略，审计反馈，以瞄准在发现的PE中的低价值成像的驱动因素。 12我们的基本工作：知识，同伴压力，情感和对后果的信念。我们使用 13一种新颖的审计反馈理论，即临床性能反馈干预理论（CP-FIT）。审核反馈是 14通过补充策略“增强”，以协助行动计划并授权临床医生改变其行为。这 15包括用于适当测试的辅助，该测试通过明确的PE评估来指导临床医生。 16个教育播客和当地冠军。在AIM 1中，我们将开发，完善和运营Demplationation 17个策略组件。我们将对审计反馈报告的原型进行认知测试，开发 18电子健康记录（EHR）综合援助，记录教育播客，并识别和训练当地冠军。在 19 AIM 2，我们将在5 eds中试用EAF策略的替代版本，以评估可接受性和适当性。我们 20将改变反馈（当地冠军与部门主席），教育播客的交付（与 21或没有真正的患者叙述），以及适当测试的帮助（静态与EHR集成辅助）确定 22这些迭代的可接受性，适当性和附加值。我们将试用该策略的不同版本来评估 CP拟合的23个方面包括复杂性，社会影响力和可操作性，CP拟合提出推动审计反馈 24周期，最终改变行为。我们将使用混合方法评估策略，并选择一种精致的策略 25多中心试验。在此K23应用程序中，我们提出了一项详细的职业发展计划 26高级实施科学策略，方法和试验设计方面的方法和技术专长。我很好 27在经验丰富的导师和顾问团队的支持下。在这个指导的职业发展奖的结尾，我将 28具有强大的经验衍生和理论知识的策略，将定位在多中心中测试该策略 29审判作为独立研究者。 30

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Managing Pulmonary Embolism.

治疗肺栓塞。

DOI：
10.1016/j.annemergmed.2023.01.019
发表时间：
2023
期刊：
Annals of emergency medicine
影响因子：
6.2
作者：
Westafer,LaurenM;Long,Brit;Gottlieb,Michael
通讯作者：
Gottlieb,Michael

Hot off the press: Stop fallin'-Geriatric fall prevention in the emergency department.

DOI：
10.1111/acem.14466
发表时间：
2022-04
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
通讯作者：

Hot off the press: the RAMPED trial-methoxyflurane for analgesia in the emergency department.

DOI：
10.1111/acem.14257
发表时间：
2021-10
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
通讯作者：

Experiences of Transgender and Gender Expansive Physicians.

DOI：
10.1001/jamanetworkopen.2022.19791
发表时间：
2022-06-01
期刊：
JAMA network open
影响因子：
13.8
作者：
通讯作者：

Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments.

采用静脉内和肌肉内化学约束治疗儿童行为健康患者：来自全国急诊科样本的结果。

DOI：
10.1111/acem.14754
发表时间：
2023
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
0
作者：
Tang,AndrewS;Shieh,Meng-Shiou;Pekow,PenelopeS;Prentiss,KimballA;Lindenauer,PeterK;Westafer,LaurenM
通讯作者：
Westafer,LaurenM