Sickle Cell Improvement: ENhancing Care in the Emergency Department (SCIENCE)

镰状细胞病的改善：加强急诊科的护理（科学）

基本信息

批准号：
10311624
负责人：
Amanda M Brandow
金额：
$ 54.8万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
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 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10311624
关键词：
Abnormal Hemoglobins Accident and Emergency department Accounting Acute Acute Pain Adherence Adoption Affect American Society of Hematology Applied Research Caring Child Child Care Chronic Clinical Collaborations Data Disease Dissemination and Implementation Dose Effectiveness Emergency Care Emergency Medicine Emergency department visit Engineering Erythrocytes Family Feedback Foundations Funding Goals Grant Guideline Adherence Guidelines Health Hematological Disease Hospitalization Inherited Institutes Institution Intervention Interview Journals Medicine Modification National Heart, Lung, and Blood Institute New England Nursing Research Opioid Outcome Pain Pain management Pathway interactions Patients Protocols documentation Quality of Care Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recurrence Registries Reporting Research Methodology Sickle Cell Sickle Cell Anemia Site Stress Structural Racism Structure Testing Theoretical Domains framework Time United States United States National Academy of Sciences Universities Visit Vulnerable Populations Washington Work analytical method base combat data tools design dissemination research effectiveness implementation study effectiveness implementation trial evidence base evidence based guidelines group intervention hospitalization rates implementation facilitation implementation outcomes implementation research implementation science implementation strategy improved multidisciplinary pain score pediatric emergency sickling treatment adherence treatment guidelines vaso-occlusive crisis vaso-occlusive pain

项目摘要

PROJECT SUMMARY Sickle cell disease (SCD) is an inherited blood disorder affecting approximately 36,000 children in the United States, approximately 90% of whom are Black. The disease is characterized by recurrent, severe pain crises which result in high rates of emergency department visits and hospitalizations, and decreased quality of life. The National Heart, Lung and Blood Institute, as well as the American Society of Hematology, have endorsed pain management guidelines regarding the timeliness of care for children presenting with these acute pain crises. These evidence based guidelines are infrequently followed, resulting in increased pain and hospitalizations. In additional to other barriers to following the guideline, structural racism has been proposed as a significant contributor and the New England Journal of Medicine recently called for the institution of SCD- specific pain management protocols to combat structural racism and reduce time to opioid administration. Our long-term goal is to improve the care and health outcomes of children with acute painful vaso-occlusive crisis treated in the emergency department. Our overall aim is to test a care pathway using multifaceted implementation strategies to increase guideline adherent care for children in the emergency department with acute painful vaso-occlusive crisis. Our primary aims are: 1) To compare the primary implementation outcomes of Reach, Adoption, and Implementation for the care pathway for treatment of children with acute painful vaso- occlusive crisis in the emergency department, between control and intervention groups and 2) To compare the primary clinical outcomes of guideline adherent care for opioid dose timing, hospitalization rates, and pain scores for the care pathway for the treatment of children with acute painful vaso-occlusive crises in the emergency department between control and intervention groups. We will test these aims using a randomized, multicenter stepped wedge design to conduct a type III hybrid effectiveness-implementation trial of the care pathway. Our proposal will institute the care pathway across seven emergency departments with the goal of improving guideline adherent care for children with SCD presenting with an acute pain crisis, thereby improving pain, decreasing hospitalizations and improving quality of life for this vulnerable population.

项目概要镰状细胞病 (SCD) 是一种遗传性血液疾病，影响美国约 36,000 名儿童州，大约 90% 是黑人。该疾病的特点是反复发作的严重疼痛危机这导致急诊就诊和住院率高，生活质量下降。美国国家心肺血液研究所以及美国血液学会已认可关于及时护理患有这些急性疼痛的儿童的疼痛管理指南危机。这些基于证据的指南很少被遵循，导致疼痛和疼痛增加住院治疗。除了遵循该指南的其他障碍之外，还提出了结构性种族主义作为重要贡献者，《新英格兰医学杂志》最近呼吁建立 SCD- 打击结构性种族主义并减少阿片类药物给药时间的具体疼痛管理方案。我们的长期目标是改善患有急性疼痛性血管闭塞的儿童的护理和健康结果危机在急诊室接受治疗。我们的总体目标是使用多方面测试护理途径实施战略，以加强对急诊科儿童的指导依从性护理急性疼痛性血管闭塞危象。我们的主要目标是： 1) 比较主要实施结果治疗患有急性血管疼痛的儿童的护理途径的范围、采用和实施急诊科中对照组和干预组之间的闭塞危机 2) 比较阿片类药物剂量时机、住院率和疼痛的依从性护理指南的主要临床结果治疗患有急性疼痛性血管闭塞危象的儿童的护理途径评分对照组和干预组之间的急诊科。我们将使用随机的、多中心阶梯楔形设计进行 III 型混合有效性实施护理试验途径。我们的提案将在七个急诊科建立护理途径，目标是改善对患有急性疼痛危机的 SCD 儿童的指南依从性护理，从而改善减轻疼痛、减少住院治疗并提高这一弱势群体的生活质量。