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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要腹痛是急诊科患者最常见的主诉。对这些患者的评估经常涉及使用计算机断层扫描 (CT)。迄今为止针对该适应症使用最广泛的成像方式，但使患者暴露在辐射水平下众所周知，用于 CT 扫描的静脉注射造影剂也会导致癌症。肾脏损伤，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 (US)，对于检测腹痛的紧急原因具有很高的准确性根据指南，不要让患者接触致癌辐射或损害肾脏的造影剂。提倡使用 US 和 MRI 代替 CT 的情况存在，但医生并未常规遵循此 K08。该提案将评估在急诊科使用超声和 MRI 的障碍和促进因素。 Repplinger 博士是威斯康星大学麦迪逊分校的助理教授，主要任命在 BerbeeWalsh 急诊医学科和交叉任命的科放射学。他的研究重点是评估 CT 的无辐射成像替代方案，特别是使用由于他在组装和组装过程中所采取的谨慎态度，这一系列调查非常成功。维持一支由具有医学物理、紧急护理、放射学、健康服务研究以及他独特的资历来自这三年的 K08 的支持。该奖项将为 Repplinger 博士提供成功完成他的提议所需的专门时间此外，他将能够从事将显着促进职业发展的活动。加速他成为一名独立调查员的进程。拟议的目标是： 1) 确定高影响障碍和促进因素，以遵循指南使用 MRI 和美国在 ED 中；2) 设计针对高影响障碍的候选干预措施，并使用它进行完善主要利益相关者的意见；以及 3) 测试候选干预包对图像测试的影响儿科阑尾炎指南的遵守情况将使用混合方法来实现。方法：对目标 1 和 2 的焦点小组以及来自我们电子健康的管理数据进行定性分析目标3的记录。