Identifying Barriers and Facilitators to the Implementation of Radiation-Free Imaging Protocols in the Emergency Department

确定急诊科实施无辐射成像方案的障碍和促进因素

• 批准号: 9350338
• 负责人: Michael Dean Repplinger
• 金额: $ 16.28万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-09 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9350338
• 关键词: Abdomen; Abdominal Pain; Accident and Emergency department; Address; Adherence; Advocate; Appendectomy; Appendicitis; Appointment; Attitude; Award; Behavior; Cancer Etiology; Caring; Cessation of life; Childhood; Code; Contrast Media; Data; Diagnosis; Dialysis procedure; Digestive System Disorders; Electronic Health Record; Elements; Emergency Care; Emergency Department Physician; Emergency Medicine; Emergency Situation; Evaluation; Exposure to; Feedback; Focus Groups; Funding; Future; Goals; Guideline Adherence; Guidelines; Health Services Research; Healthcare; Hospital Administrators; Image; Injury; Intervention; Intravenous; Investigation; Ionizing radiation; K-Series Research Career Programs; Kidney; Kidney Diseases; Kidney Failure; Knowledge; Literature; Magnetic Resonance Imaging; Malignant Neoplasms; Medical; Medical Imaging; Medical Research; Methods; Mission; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrotoxic; Patient Care; Patients; Physicians; Physics; Population; Practice Guidelines; Procedures; Protocols documentation; Provider; Radiation; Radiation-Induced Cancer; Radiologic Health; Radiology Specialty; Research; Research Personnel; Research Project Grants; Research Training; Risk; Scanning; Science; Site; Structure; System; Terminology; Testing; Time; Time Series Analysis; Training; Ultrasonography; United States; Universities; Wisconsin; Work; X-Ray Computed Tomography; accurate diagnosis; base; career; career development; design; diagnostic accuracy; evidence base; evidence based guidelines; gastrointestinal; imaging modality; improved; injured; nephrotoxicity; patient safety; pediatric patients; pregnant; prevent; professor; rapid diagnosis; therapy design; time use; Abdomen; Abdominal Pain; Accident and Emergency department; Address; Adherence; Advocate; Appendectomy; Appendicitis; Appointment; Attitude; Award; Behavior; Cancer Etiology; Caring; Cessation of life; Childhood; Code; Contrast Media; Data; Diagnosis; Dialysis procedure; Digestive System Disorders; Electronic Health Record; Elements; Emergency Care; Emergency Department Physician; Emergency Medicine; Emergency Situation; Evaluation; Exposure to; Feedback; Focus Groups; Funding; Future; Goals; Guideline Adherence; Guidelines; Health Services Research; Healthcare; Hospital Administrators; Image; Injury; Intervention; Intravenous; Investigation; Ionizing radiation; K-Series Research Career Programs; Kidney; Kidney Diseases; Kidney Failure; Knowledge; Literature; Magnetic Resonance Imaging; Malignant Neoplasms; Medical; Medical Imaging; Medical Research; Methods; Mission; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrotoxic; Patient Care; Patients; Physicians; Physics; Population; Practice Guidelines; Procedures; Protocols documentation; Provider; Radiation; Radiation-Induced Cancer; Radiologic Health; Radiology Specialty; Research; Research Personnel; Research Project Grants; Research Training; Risk; Scanning; Science; Site; Structure; System; Terminology; Testing; Time; Time Series Analysis; Training; Ultrasonography; United States; Universities; Wisconsin; Work; X-Ray Computed Tomography; accurate diagnosis; base; career; career development; design; diagnostic accuracy; evidence base; evidence based guidelines; gastrointestinal; imaging modality; improved; injured; nephrotoxicity; patient safety; pediatric patients; pregnant; prevent; professor; rapid diagnosis; therapy design; time use

PROJECT SUMMARY / ABSTRACT Abdominal pain is the single most frequent complaint for patients seen in the emergency department. The evaluation of these patients frequently involves the use of medical imaging. Computed tomography (CT) is by far the most widely used imaging modality for this indication, but exposes patients to levels of radiation that put them at risk for developing cancer. The intravenous contrast agent used for CT scans is also known to cause kidney injury, leading to dialysis and even death. Alternative imaging tests, including magnetic resonance imaging (MRI) and ultrasound (US), have high accuracy for detecting emergent causes of abdominal pain and do not expose patients to cancer-causing radiation nor kidney damaging contrast agents. Though guidelines advocating the use of US and MRI instead of CT exist, physicians are not routinely following them. This K08 proposal will evaluate the barriers and facilitators to the use of US and MRI in the emergency department. Dr. Repplinger is an Assistant Professor at the University of Wisconsin – Madison, with a primary appointment in the BerbeeWalsh Department of Emergency Medicine and cross-appointment in the Department of Radiology. His research focuses on evaluating radiation-free imaging alternatives to CT, particularly the use of MRI. This line of investigation has been very successful due to the care he has taken in assembling and maintaining an interdisciplinary team of collaborators with expertise in medical physics, emergency care, radiology, and health services research as well as his unique qualifications. Support from this 3-year K08 award would provide Dr. Repplinger with the dedicated time needed to successfully complete his proposed research project. Further, he would be able to pursue career development activities that will significantly accelerate his progress toward becoming an independent investigator. The proposed aims are: 1) Identify high impact barriers and facilitators to guideline-adherent use of MRI and US in the ED; 2) Design a candidate intervention bundle targeted to high impact barriers and refine it using input from key stakeholders; and 3) Test the impact of the candidate intervention bundle on image test guideline adherence for pediatric appendicitis. These aims will be accomplished using a mixed-methods approach: qualitative analysis of focus groups for aims 1 & 2 and administrative data from our electronic health record for aim 3.

项目摘要 /摘要 腹痛是急诊室中最常见的投诉。 对这些患者的评估经常涉及医学成像。计算机断层扫描（CT）由 对于这种适应症而言，最广泛使用的成像方式，但使患者接触到放射线的水平 他们有患癌症的风险。还已知用于CT扫描的静脉造影剂引起 肾脏受伤，导致透析甚至死亡。替代成像测试，包括磁共振 成像（MRI）和超声（美国）具有很高的准确性，可检测出腹痛和 请勿使患者暴露于引起癌症的辐射或肾脏破坏对比剂的情况。虽然指南 主张使用我们和MRI而不是CT的使用，医生并不常规地关注他们。这个K08 提案将评估急诊室使用我们和MRI的障碍和促进者。 Repplinger博士是威斯康星大学 - 麦迪逊分校的助理教授 在Berbeewalsh急诊医学和交叉任命部门 放射学。他的研究重点是评估CT的无辐射成像替代品，尤其是使用 MRI。由于他在组装和 维护一个跨学科的合作者团队 放射学和卫生服务研究以及他的独特资格。这个3年K08的支持 奖项将为Repplinger博士提供成功完成他的建议所需的专门时间 研究项目。此外，他将能够从事职业发展活动 加速他成为独立调查员的进步。 拟议的目的是：1）确定高影响障碍和促进者，以遵守MRI和 我们在急诊室； 2）设计针对高冲击障碍的候选干预捆绑包，并使用 主要利益相关者的投入； 3）测试候选干预捆绑包对图像测试的影响 小儿阑尾炎的指南。这些目标将使用混合方法来实现 方法：目标1和2的焦点小组的定性分析以及我们电子健康的行政数据 AIM 3的记录。