CT DOSE Collaboratory

CT剂量合作实验室

• 批准号: 8762155
• 负责人: REBECCA SMITH-BINDMAN
• 金额: $ 132.83万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8762155
• 关键词: Adopted; Advocate; Affect; Beds; Benchmarking; Biometry; Canada; Caring; Chest; Clinics and Hospitals; Cohort Studies; Collaborations; Communities; Computer software; Country; Data; Data Collection; Devices; Diagnosis; Dimensions; Dose; Educational process of instructing; Elements; Europe; Fee-for-Service Plans; Feedback; Funding; Goals; Health; Health system; Healthcare; Healthcare Systems; Hospitals; Individual; Institution; Intervention; Interview; Knowledge; Leadership; Learning; Letters; Malignant Neoplasms; Manufacturer Name; Medical; Medical Imaging; Methods; Metric; Modeling; Monitor; Observational Study; Participant; Patients; Phase; Physics; Practice Guidelines; Process; Public Health; Radiation; Radiation Dosage; Radiation Physics; Radiology Specialty; Randomized; Randomized Controlled Trials; Readiness; Recruitment Activity; Registries; Research; Research Personnel; Safety; Scanning; Scientist; Services; Site; Solutions; Suggestion; Surveys; System; Testing; Time; Tomography, Computed, Scanners; Variant; Veterans; Work; X-Ray Computed Tomography; base; cancer risk; care systems; clinical practice; collaboratory; community based care; design; evidence base; experience; health care delivery; health care service organization; implementation science; implementation trial; improved; informant; interest; meetings; multi-component intervention; operation; organizational structure; pragmatic trial; programs; public health relevance; trial comparing

DESCRIPTION (provided by applicant): Computed tomography (CT) is frequently used for medical scanning and can deliver high doses of radiation to patients. Yet because few standards exist for CT examinations, the radiation doses that patients receive during CT vary widely. Routinely, doses are higher than needed for medical diagnoses-and high enough to be associated with increased cancer risk. The proposed project is a multisite collaboration studying improved standards for conducting CT, including the radiation doses used, and developing strategies to apply (implement) and spread (disseminate) these standards in different clinics and hospitals. The project will use a mixture of methods including a randomized controlled trial, observational data, and key informant interviews. The work strives to improve CT safety and cancers associated with radiation from CT by lowering the doses that patients receive. The project includes an implementation trial to learn how to broadly teach clinics and hospitals about the best and safest CT practices. The process of change will vary with different health care settings and different organizational structures. This study seeks to understand the best strategies to adapt CT safety interventions by learning what factors improve both implementation and dissemination of the best practice guidelines. Our project is a partnership with diverse healthcare delivery organizations in the US, Canada, and Europe in collaboration with Bayer Health. These public, private, academic, and community-based care systems include both fee-for-service and prepaid care organizations and will serve as our test bed sites. Non-US institutions are included since radiation safety around medical imaging is a great concern in these countries, and their hospitals and researchers have experience in CT radiation dose monitoring and optimizing. Our research team includes scientists with expertise in biostatistics, radiology, radiation physics, and dissemination and implementation sciences, and health system leaders who focus on quality improvement and are champions for optimizing medical imaging doses. All participating health care systems already use eXposure, the Bayer Health software for radiation dose monitoring. The purchase of eXposure shows the interest and commitment of the health care organizations to collecting data on the radiation doses used in clinical practice and using data to optimize medical imaging doses. The sites are thus ideal partners for this project. Each has project champions, but not the expertise or strategy to optimize CT radiation dosages. Organizing the project around existing relationships that can already collect data securely from a range of software platforms minimizes data collection complexity, overcoming a main hurdle in developing a widely implementable quality improvement program. This will allow our research team to focus on the proposed study aims of disseminating and implementing change. We will 1) conduct a randomized controlled pragmatic trial with a stepped-wedge design to compare simple audit with feedback vs. a tailored, multicomponent intervention as strategies for facility-level optimization of CT radiation dose, 2) assess the degree of implementation and identify facilitators, barriers and successful and failed strategies for implementing dose optimization and sustaining improvements in CT radiation dosing over 2 years following intervention, and 3) broadly disseminate and evaluate dissemination of the intervention at several institutions, focusing on the most effective solutions from the pragmatic trial.

描述（由申请人提供）：计算机断层扫描（CT）经常用于医学扫描，可以向患者提供高剂量的辐射。然而，由于CT检查的标准很少，因此患者在CT期间接受的辐射剂量差异很大。通常，剂量高于医疗诊断所需的剂量，并且足够高，以与癌症风险增加相关。拟议的项目是一项多站点协作，研究了进行CT的改进标准，包括所使用的辐射剂量，以及制定在不同诊所和医院中应用（实施）和传播（分发）这些标准的策略。该项目将使用包括随机对照试验，观察数据和关键线人访谈在内的方法的混合。这项工作旨在通过降低患者接受的剂量来提高CT安全性和与CT辐射相关的癌症。该项目包括一项实施试验，以了解如何广泛教诊所和医院有关最佳和最安全的CT实践。变革过程将随着不同的医疗保健环境和不同的组织结构而变化。这项研究试图通过了解哪些因素可以改善最佳实践指南的实施和传播，以了解适应CT安全干预措施的最佳策略。我们的项目是与拜耳健康合作与美国，加拿大和欧洲各种医疗保健提供组织的合作伙伴关系。这些公共，私人，学术和社区的护理系统包括支付费用和预付费护理组织，并将作为我们的测试床网站。由于医学成像周围的辐射安全性在这些国家是一个非常关注的问题，因此包括非美国机构，其医院和研究人员在CT辐射剂量监测和优化方面具有经验。我们的研究团队包括具有生物统计学，放射学，放射物理学以及传播和实施科学专业知识的科学家，以及专注于质量改进的卫生系统领导者，并且是优化医学成像剂量的拥护者。所有参与的卫生保健系统都已经使用暴露，这是用于辐射剂量监测的拜耳健康软件。购买曝光表明，医疗保健组织对收集临床实践中使用的辐射剂量的数据的兴趣和承诺，并使用数据来优化医学成像剂量。因此，这些站点是该项目的理想合作伙伴。每个人都有项目冠军，但没有优化CT辐射剂量的专业知识或策略。组织项目围绕现有关系，这些关系已经可以从一系列软件平台中牢固收集数据，从而最大程度地降低了数据收集的复杂性，从而克服了开发可实现的质量改进计划的主要障碍。这将使我们的研究团队能够专注于拟议的研究目标，以传播和实施变革。我们将1）进行一项随机对照的实用试验，其阶梯式设计设计与反馈与量身定制的，多组分干预的反馈与设施级别优化CT辐射剂量优化的策略，2）评估实施程度，并确定障碍和维持3次进化的策略，并确定促进和失败的策略，以进行促进和失败的策略。在几个机构中传播和评估干预措施的传播，重点是实用试验的最有效解决方案。