A Rapid-Throughput Feedback Intervention for Population-Scale Communication Quali

针对人口规模通信质量的快速吞吐量反馈干预

• 批准号: 7933959
• 负责人: Michael Henry Farrell
• 金额: $ 50万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7933959
• 关键词: Address; Adoption; Age; American; Area; Back; Behavior; Bioethics; Bioethics Consultants; Birth; Blood; Businesses; Characteristics; Child; Child health care; Clinical Services; Communication; Communities; Counseling; Cystic Fibrosis; Data; Data Collection; Disease; Emerging Technologies; Employee; Ethical Issues; Factor Analysis; Feedback; Female; Future; Genetic Carriers; Genetic Screening; Genetic Transcription; Geographic Locations; Goals; Hand; Health Communication; Health Personnel; Healthcare; Hemoglobinopathies; Human Genome Project; Individual; Infant; Inservice Training; Intervention; Knowledge; Lead; Left; Lung; Measures; Methods; Minority Groups; Molecular Genetics; Neonatal Screening; Newborn Infant; Occupations; Outcome; Parents; Participant; Patients; Performance; Phase; Phase III Clinical Trials; Physicians; Population; Population Intervention; Positioning Attribute; Procedures; Process; Protocols documentation; Public Health; Publishing; Quality Indicator; Randomized Controlled Trials; Recovery; Relative (related person); Reporting; Research; Resources; Running; Safety; Sample Size; Sampling; Schedule; Scientific Advances and Accomplishments; Screening Result; Screening procedure; Series; Services; Sickle Cell; Solutions; Staging; Techniques; Technology; Test Result; Testing; Time; TimeLine; Training; Underrepresented Minority; United States National Institutes of Health; Wisconsin; abstracting; behavior change; communication behavior; design; experience; follow-up; improved; medical specialties; outer surface lipoprotein; policy implication; post intervention; programs; psychosocial; rehearsal; software development; therapy design; time interval

DESCRIPTION (provided by applicant): and abstract This application addresses broad Challenge Area (02) Bioethics, and specific Challenge Topic 02-OD(OSP)-101, "Unique ethical issues posed by emerging technologies." BACKGROUND. Genetic and molecular testing technologies have expanded rapidly into the newborn screening programs that are used for nearly every U.S. newborn. These techniques lead to biomedical benefit for some infants but troubling psychosocial harms for far more infants who have false positive or genetic carrier results. A mechanism is needed to insure that screening lead to more good than harm, in order to insure the long-term survival of newborn screening for the lung condition cystic fibrosis (CF) and the blood condition sickle cell hemoglobinopathy (SCH). Since many psychosocial problems are the result of parent misunderstandings about the results' significance, we are responding to the challenge by developing a mechanism to assess and improve the processes and outcomes of clinicians' communication with parents. We have previously developed a communication assessment method that is feasible for use on a population scale, using rehearsals and a quality indicator approach to operationalize individual behaviors like the number and relative timing of jargon words, assessments of understanding, and specific content messages. In the current study we will develop and evaluate a rapid-throughput technique to provide feedback and support to clinicians about their communication quality indicator scores. AIMS. (1) To pilot-test and finalize design of a rapid-throughput feedback and support intervention designed to improve processes of communication after newborn screening for CF and SCH. (2) To determine whether rapid provision of feedback via a "report card" will improve clinicians' communication quality indicator scores. The proposal also responds to the economy-stimulating goals of the American Recovery and Reinvestment Act by hiring 6 new employees and engaging with two U.S. small businesses to do our research transcription and software development. METHODS. We have adapted our communication assessment method to be done on a rapid-throughput timeline that should have immediate utility for participating clinicians. The project includes 3 tightly-timed phases. In phase 1 (months 1-2) we will finalize informational content of the report card and accompanying support materials, and hire and train the new employees to accomplish the rapid-throughput procedure. In phase 2 (months 3-6) we will pilot test the procedure with a series of resident physicians. Phase 3 (months 7-22) will be a randomized controlled trial of the report card and materials over a sample of 400 child health providers identified via a random search of the AMA Masterfile. Participant scores on a panel of communication quality indicators will be measured at baseline and follow-up after sending a random sample the report card feedback and support materials. SIGNIFICANCE. Improving communication is said to be an important solution to bioethical problems, and there is ample data about problems with clinicians' communication. Most previously published efforts to assess and improve communication require more resources than would be feasible for routine widespread use. An effective mechanism to improve communication quality will help to answer bioethicist challenges about the safety of genetic screening, and insure that newborn screening for CF and SCH lead to more good than harm. In the long run, we believe that a population-scale method to improve communication will benefit health providers in other specialties and the experiences and outcomes of their patients. The U.S. public health community screens nearly every U.S. newborn for inborn diseases, but misunderstanding about the meaning of test results can lead to serious psychosocial problems, the raising of public concerns, and delays in implementing new screening tests. This proposal responds to the challenge of insuring that more good than harm comes from use of new screening technologies, so that newborn screening may expand its services to new communities. The project will implement and evaluate a population-scale method designed to improve clinicians' communication about newborn screening results.

描述（由申请人提供）： 和摘要此应用程序解决了广泛的挑战领域 (02) 生物伦理学，以及具体的挑战主题 02-OD(OSP)-101，“新兴技术带来的独特伦理问题”。 背景。基因和分子检测技术已迅速扩展到几乎每个美国新生儿都使用的新生儿筛查项目。这些技术为一些婴儿带来了生物医学益处，但对更多出现假阳性或遗传携带者结果的婴儿造成了令人不安的心理社会伤害。需要一种机制来确保筛查利大于弊，以确保肺病囊性纤维化 (CF) 和血液病镰状细胞血红蛋白病 (SCH) 筛查新生儿的长期生存。由于许多心理社会问题是家长对结果意义的误解造成的，因此我们通过开发一种机制来评估和改进临床医生与家长沟通的过程和结果来应对这一挑战。我们之前开发了一种可在人口规模上使用的沟通评估方法，使用排练和质量指标方法来操作个人行为，例如行话的数量和相对时间、理解评估和特定内容信息。在当前的研究中，我们将开发和评估一种快速吞吐量技术，为临床医生提供有关其沟通质量指标评分的反馈和支持。 目标。 (1) 试点测试并最终确定快速反馈和支持干预措施的设计，旨在改善新生儿 CF 和 SCH 筛查后的沟通过程。 (2) 确定通过“成绩单”快速提供反馈是否会提高临床医生的沟通质量指标得分。该提案还通过雇用 6 名新员工并与两家美国小企业合作进行研究转录和软件开发来响应《美国复苏和再投资法案》的经济刺激目标。 方法。我们已经调整了我们的沟通评估方法，使其能够在快速吞吐量的时间内完成，这对于参与的临床医生应该具有立即的效用。该项目包括 3 个时间紧迫的阶段。在第一阶段（第 1-2 个月），我们将最终确定报告卡和随附支持材料的信息内容，并雇用和培训新员工以完成快速处理程序。在第二阶段（第 3-6 个月），我们将与一系列住院医生一起对该程序进行试点测试。第 3 阶段（第 7-22 个月）将是对通过 AMA 主文件随机搜索确定的 400 名儿童健康提供者样本进行的报告卡和材料的随机对照试验。在随机发送成绩单反馈和支持材料样本后，将在基线和后续阶段测量参与者在沟通质量指标上的得分。意义。据说改善沟通是解决生物伦理问题的重要方法，并且有大量数据表明临床医生的沟通存在问题。大多数先前发表的评估和改善沟通的努力需要比常规广泛使用可行的资源更多的资源。提高沟通质量的有效机制将有助于回答生物伦理学家关于基因筛查安全性的挑战，并确保新生儿 CF 和 SCH 筛查利大于弊。从长远来看，我们相信，改善沟通的人口规模方法将有利于其他专业的医疗服务提供者以及患者的经历和结果。美国公共卫生界对几乎每个美国新生儿进行先天性疾病筛查，但对检测结果含义的误解可能会导致严重的社会心理问题、引发公众担忧以及推迟实施新​​的筛查检测。该提案应对了确保使用新筛查技术利大于弊的挑战，以便新生儿筛查可以将其服务扩展到新社区。该项目将实施和评估一种人口规模方法，旨在改善临床医生对新生儿筛查结果的沟通。