Quality Improvement in time to Treatment of Status Epilepticus (QuITT-SE)

癫痫持续状态治疗的及时质量改进 (QuITT-SE)

• 批准号: 10720249
• 负责人: ADAM P. OSTENDORF
• 金额: $ 76.52万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-20 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10720249
• 关键词: Academy; Acute; Address; Admission activity; Adoption; American; Anticonvulsants; Benzodiazepines; Brain Death; Brain Injuries; Caring; Categories; Cerebrum; Cessation of life; Charge; Child; Childhood; Cluster randomized trial; Conscious; Diagnosis; Dose; Evidence based intervention; Geography; Goals; Guidelines; Healthcare Systems; Hospital Costs; Hospitalization; Hospitalized Child; Hospitals; Individual; Intensive Care; Intervention; Measures; Mechanical ventilation; Methodology; Methods; Morbidity - disease rate; Neurology; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Performance; Phase; Practical Robust Implementation and Sustainability Model; Process; Public Health; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Refractory; Research; Resources; Safety; Seizures; Site; Societies; Standardization; Statistical Computing; Status Epilepticus; Testing; Time; United States; cost; demographics; design; effectiveness/implementation design; effectiveness/implementation trial; efficacy outcomes; evidence based guidelines; implementation determinants; implementation framework; improved; improved outcome; intervention effect; mortality; post implementation; process improvement

Acute seizures may evolve into status epilepticus (SE), i.e., prolonged or repeated seizures without regaining consciousness, resulting in irreversible brain injury or death costing ~$4 billion annually to the US healthcare system. If seizures are treated rapidly with a correctly-dosed benzodiazepine (BZD), SE and its associated morbidity and mortality may be averted. For instance, children treated after 10 minutes of seizure onset are 11 times more likely to die during their hospitalization than patients treated earlier. Therefore, the American Academy of Neurology identified time to treatment as a quality metric to evaluate SE care. Despite these evidence-based recommendations, delayed seizure treatment remains the status quo in many centers. The Quality Improvement in Time to Treatment of Status Epilepticus (QuITT-SE) study will examine the implementation and effects of a standardized set of QI interventions across pediatric hospitals with diversity in geography, patient demographics and resources. The proposed interventions were developed and tested in a single-center study that doubled the number of SE episodes treated within guideline timing, decreased morbidity, and mitigated over $2 million of charges in the following 17-month period. Our overarching goal is to study the implementation of these QI interventions and their effect on time to SE treatment across multiple centers utilizing an effectiveness-implementation hybrid design. The QuITT-SE trial will be a stepped-wedge cluster randomized trial across multiple sites within the Pediatric Status Epilepticus Research Group, an established consortium of hospitals with expertise in studying and treating SE in children. During this project, mixed qualitative and quantitative methods will be used to identify implementation factors related to the interventions. In addition, the use of standardized QI processes within the Practical, Robust Implementation and Sustainability Model (PRISM) will facilitate the identification of site-specific drivers and themes pertaining to delayed SE treatment, improving the generalizability of findings. The specific aims are: 1) Primary: Determine how implementing a QI bundle impacts the time to treat SE among hospitalized, non-critically ill children. 2a) Secondary: Determine the effect on Pediatric Cerebral Performance Category score among hospitalized, non-critically ill children after implementing a QI bundle. 2b) Secondary: Determine the effect of dissemination of a QI bundle on cost of hospitalization for SE among hospitalized, non-critically ill children 3) Exploratory: Explore the factors implicated in implementing a QI bundle on the time to treat SE among hospitalized children. Public Health Impact: Each year, SE results in an estimated 15,000-45,000 deaths in children in the US and costs ~$4 billion, increasing markedly with more prolonged seizures. Successful completion of QuITT-SE will produce a set of evidence-based interventions alongside an implementation framework to improve outcomes and value of SE treatment across diverse hospital settings.

急性癫痫发作可能演变成癫痫持续状态（SE），即延长或重复的癫痫发作 恢复意识，导致不可逆转的脑损伤或死亡每年造成约40亿美元的死亡 医疗保健系统。如果癫痫发作用正确剂量的苯二氮卓（BZD）迅速治疗，则SE及其 可以避免相关的发病率和死亡率。例如，癫痫发作10分钟后接受治疗的孩子 在住院期间死亡的可能性比早期治疗的患者高出11倍。因此， 美国神经病学学会将治疗时间确定为评估SE护理的质量指标。尽管 这些基于证据的建议，延迟的癫痫治疗仍然是许多中心的现状。 癫痫持续治疗时间（QUITT-SE）研究的时间的质量改善将检查 各种各样的小儿医院的一套标准化的QI干预措施的实施和影响 地理，患者人口统计和资源。提出的干预措施是在A中开发和测试的 单中心研究使指南时间内治疗的SE发作数量增加了一倍，发病率降低， 并在接下来的17个月期间减轻了200万美元的费用。我们的总体目标是研究 实施这些QI干预措施及其对使用多个中心的SE治疗的影响的影响 有效性实施混合设计。 quitt-se试验将是随机的阶梯式斜向群集 跨小儿癫痫研究小组中的多个地点进行试验，这是一个已建立的财团 在儿童学习和治疗SE方面具有专业知识的医院。在这个项目期间，定性混合在一起 定量方法将用于识别与干预措施相关的实现因素。另外， 在实践，强大的实施和可持续性模型（PRISM）中使用标准化的QI流程 将有助于识别与延迟SE治疗有关的特定地点驱动因素和主题 发现的普遍性。 具体目的是：1）主要：确定实施Qi束如何影响治疗的时间 SE在住院的，非犯下的儿童中。 2a）次要：确定对小儿脑的影响 实施QI捆绑套件后，住院的，非犯罪儿童的绩效类别得分。 2b） 次要：确定Qi捆绑包的传播对SE住院费用的影响 住院，非犯罪儿童3）探索性：探索涉及实施QI捆绑的因素 在住院儿童中治疗SE的时间。 公共卫生影响：每年SE估计会导致美国儿童死亡15,000-45,000人 耗资约40亿美元，持续持续的癫痫发作明显增加。成功完成quitt-se 将制作一套基于证据的干预措施以及一个实施框架以改善结果 在各种医院环境中，SE治疗的价值和价值。