Development and feasibility testing of a novel intervention to implement trauma triage guidelines

实施创伤分类指南的新型干预措施的开发和可行性测试

基本信息

批准号：
10193315
负责人：
Deepika Mohan
金额：
$ 27.65万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
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：
2021-04-15 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10193315
关键词：
Academy Address Adherence Aging Behavior Therapy Behavioral Behavioral Sciences Caring Characteristics Clinical Sciences Cognition Control Groups Cues Custom Decision Making Detection Development Diagnosis Diagnostic Diagnostic Errors Elderly Elements Emergency Department Physician Emergency Medicine Ensure Feedback Future Goals Gold Guidelines Health Human Independent Living Injury Intervention Interview Intuition Judgment Laboratories Literature Measures Medicine Methodology Methods Minor Music Operative Surgical Procedures Outcome Pain Participant Patient Transfer Patient Triage Patient-Focused Outcomes Patients Pattern Recognition Performance Physicians Play Power Sources Process Protocols documentation Refractory Reporting Research Research Design Research Priority Residencies Sampling Scientist Sports Standardization Structure Technology Testing Text Time Training Training Programs Trauma Triage Uncertainty United States National Institutes of Health Video Games Videoconferencing Work base cognitive process combat comparative efficacy comparison intervention disability experience feasibility testing follow-up heuristics improved injury burden insight instrument member mortality multidisciplinary novel older patient pilot trial pressure preventable death primary outcome programs provider behavior recruit resilience severe injury simulation skill acquisition skills success therapy development trauma centers virtual reality simulation

项目摘要

ABSTRACT Trauma triage predisposes to diagnostic errors because of the need for decision making under conditions of uncertainty and time-pressure. Diagnostic errors increase mortality, disability, pain, and loss of independence. Elderly patients are particularly vulnerable because they not only disproportionately experience these errors but also lack the resilience to tolerate sub-optimal care. The absence of interventions to improve the diagnostic process is a critical barrier to alleviating the burden that injury imposes on patients. In prior work, our team developed two customized, theoretically-based video games to improve the recognition of severely injured patients. The games had moderate efficacy in the laboratory, despite only variable success at engaging participants in the task. Our overarching hypothesis is that by increasing engagement we can amplify the potency of the interventions. The objective of this R21 proposal is to test the feasibility of using deliberate practice – goal-oriented training in the presence of a coach who can provide personalized, immediate feedback – to increase engagement. The research design involves recruitment of a national convenience sample of board-certified emergency physicians who will serve as trainees (n=30), pairing of the trainees with a coach, delivery of three 30-minute coaching sessions using the existing games as the training task, and assessment of the effect of the combined intervention on performance in the laboratory. The specific aims of the R21 are: 1. To assess the fidelity of intervention delivery by measuring coaching skill acquisition, coaching skill drift and protocol adherence. 2. To assess the potential effect size of the intervention by comparing trainee performance on a validated virtual simulation with a control group of physicians (n=30). 3. To assess the acceptability of the intervention by using a mixture of validated instruments and semi- structured debriefing interviews with trainees to assess their engagement with the intervention. Results will inform a future trial to compare the efficacy of different behavioral interventions in reducing diagnostic error in trauma triage, and in the long-term should help to mitigate the burden imposed by trauma on the health and independence of the aging.

抽象的创伤分类容易出现诊断错误，因为需要在以下条件下做出决策不确定性和时间压力会增加死亡率、残疾、疼痛和丧失独立性。老年患者尤其容易受到伤害，因为他们不仅不成比例地经历这些错误但也缺乏耐受次优护理的弹性，缺乏改善诊断的干预措施。在之前的工作中，我们的团队认为，流程是减轻伤害给患者带来的负担的关键障碍。开发了两款定制的、基于理论的视频游戏，以提高对重伤者的识别这些游戏在实验室中的效果中等，尽管在吸引患者方面的成功程度参差不齐。我们的首要假设是，通过增加参与度，我们可以扩大参与度。该 R21 提案的目的是测试故意使用干预措施的可行性。练习——在教练在场的情况下进行以目标为导向的训练，教练可以提供个性化的即时反馈 – 增加参与度研究设计涉及招募全国便利样本。经委员会认证的急诊医师将作为受训者（n = 30），为受训者与教练配对，以现有比赛为训练任务，进行3次30分钟的辅导，并进行评估 R21 的具体目标是： 1. 通过测量教练技能获取、教练技能漂移来评估干预实施的保真度和协议遵守情况。 2. 通过比较受训者在经过验证的结果上的表现来评估干预措施的潜在效果大小与对照组医生（n=30）进行虚拟模拟。 3. 通过使用经过验证的工具和半独立工具的组合来评估干预措施的可接受性对受训者进行结构化汇报访谈，以评估他们对干预的参与程度。结果将为未来的试验提供信息，以比较不同行为干预措施在减少创伤分类中的诊断错误，从长远来看应该有助于减轻创伤对人造成的负担健康和老龄化的独立性。