Prevalence and correlates of pediatric guideline deviation across 9 health facilities

9 个卫生机构儿科指南偏差的患病率和相关性

基本信息

批准号：
10019583
负责人：
Arianna Rubin Means
金额：
$ 7.78万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-17 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10019583
关键词：
2 year old Acute Address Adherence Admission activity Africa Age Antibiotics Asia Bangladesh Behavior Burkina Faso Caring Cessation of life Child Child Health Child Mortality Childhood Clinical Clinical Management Clinical Treatment Clinical Trials Database Complex Country Data Data Analyses Data Collection Data Set Diagnosis Diagnostic Diarrhea Disease Documentation Dysentery Ensure Evidence based intervention Exhibits Feedback Focus Groups Frequencies Goals Guideline Adherence Guidelines Health Health Personnel Health care facility Hospitalized Child Household Inpatients Intake Intervention Kenya Knowledge Malawi Malnutrition Maps Modeling Oral Outcome Pakistan Patient Self-Report Patients Pneumonia Prevalence Provider Quality of Care Recommendation Rehydrations Research Resources Risk Risk Factors Salts Series Severity of illness Site Surveys Sustainable Development Syndrome Target Populations Training Triage Uganda World Health Organization Zinc attributable mortality clinical decision-making cohort comorbidity contextual factors design effective intervention evidence base hospital organization implementation science implementation strategy improved innovation interdisciplinary approach lens low and middle-income countries mortality nutrition prevent preventable death treatment guidelines uptake

项目摘要

ABSTRACT An estimated 15,000 children under the age of five die every day. Primary causes of mortality include pneumonia and diarrhea, and nearly half of deaths are attributable to undernutrition. These syndromes all have available interventions to reduce mortality, however in many settings acutely ill children are not provided necessary evidence-based care. It is estimated that over half of child deaths are preventable with simple, existing, appropriately applied evidence-based interventions. Pediatric clinical treatment guidelines synthesize evidence to ensure that all children are treated with high quality care. Yet, fidelity to guidelines is variable and guideline knowledge exceeds adherence to recommendations. The objective of this study is to describe and evaluate the complex factors influencing pediatric guideline deviation in low-and-middle-income countries where most preventable pediatric deaths occur. This evidence is crucial for developing appropriate implementation strategies that can effectively improve pediatric quality of care in low-resource settings. This study involves both secondary data analysis and primary data collection and is nested within the Childhood Acute Illness and Nutrition (CHAIN) project, which has established a global research network to investigate risk factors for death in acutely ill children. This study will utilize existing CHAIN cohort data from nine health facilities in six countries to evaluate the frequency with which health providers deviate from established pediatric treatment guidelines, and factors that influence deviation. We will extract diagnostic and treatment criteria from each of the six country national guidelines, specifically for pneumonia, diarrhea, and severe acute malnutrition (SAM) sub-syndromes. We will map these criteria across CHAIN cohort data to identify the frequency with which providers deviate from the national guidelines on which they have been trained. We will additionally analyze CHAIN intake data to identify patient-level, provider-level, and contextual factors influencing provider deviation from guidelines. This will generate valuable information regarding multi-level factors that influence clinical decision making. Findings regarding the prevalence of guideline deviation across CHAIN will be used to identify the CHAIN site with the lowest observed guideline adherence across targeted syndromes. Primary qualitative data collection will take place in this site wherein health providers and supervisors will participate in focus group discussions (FGDs). Qualitative data collection and analysis will be guided by the Theoretical Domains Framework, an implementation science framework that can be applied to identify determinants of behavior. The combination of secondary data analysis and primary data collection will allow for triangulation between self-reported influences and observed influences of guideline deviation. This study is an innovative approach to rapidly understand the complex factors influencing quality of care for vulnerable children, providing an opportunity to develop optimized implementation strategies to improve guideline adherence and reduce preventable child mortality.

抽象的据估计，每天有 15,000 名五岁以下儿童死亡。死亡的主要原因包括肺炎和腹泻，近一半的死亡归因于营养不良。这些综合症都可以降低死亡率的干预措施，但在许多情况下，并没有为重病儿童提供必要的干预措施循证护理。据估计，超过一半的儿童死亡可以通过简单的、现有的、适当应用循证干预措施。儿科临床治疗指南综合证据确保所有儿童都得到高质量的护理。然而，对指导方针的忠诚度是可变的，并且指导方针知识超过了对建议的遵守。本研究的目的是描述和评估影响低收入和中等收入国家儿科指南偏差的复杂因素发生可预防的儿科死亡。该证据对于制定适当的实施策略至关重要可以有效提高资源匮乏地区的儿科护理质量。这项研究涉及中学数据分析和主要数据收集，嵌套在儿童急性疾病和营养 (CHAIN) 中该项目建立了一个全球研究网络，调查急症儿童死亡的危险因素。这项研究将利用来自六个国家的九个卫生机构的现有 CHAIN 队列数据来评估医疗服务提供者偏离既定儿科治疗指南的频率以及导致影响偏差。我们将从六个国家/地区分别提取诊断和治疗标准指南，特别是针对肺炎、腹泻和严重急性营养不良 (SAM) 亚综合征的指南。我们将将这些标准映射到 CHAIN 队列数据中，以确定提供者偏离标准的频率他们接受过培训的国家准则。我们还将额外分析 CHAIN 摄入数据以确定患者层面、提供者层面以及影响提供者偏离指南的背景因素。这将生成有关影响临床决策的多层次因素的有价值的信息。关于整个 CHAIN 指南偏差发生率的调查结果将用于识别 CHAIN 站点在目标综合征中观察到的指南遵守率最低。主要定性数据收集将在该网站进行，其中卫生服务提供者和主管将参加焦点小组讨论（FGD）。定性数据收集和分析将在理论领域框架的指导下进行，该框架是一个可用于识别行为决定因素的实施科学框架。的组合二次数据分析和主要数据收集将允许在自我报告的影响之间进行三角测量并观察指南偏差的影响。这项研究是一种快速了解影响弱势儿童护理质量的复杂因素，提供了优化发展的机会提高指南遵守率和降低可预防儿童死亡率的实施战略。