Using video games to increase implementation of clinical practice guidelines in trauma triage

使用视频游戏加强创伤分诊临床实践指南的实施

基本信息

批准号：
10582783
负责人：
Deepika Mohan
金额：
$ 59.71万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-03-15 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10582783
关键词：
Academy Accident and Emergency department Address Affect Aging Agreement Behavior Behavior assessment Behavioral Behavioral Sciences Calibration Caring Clinical Practice Guideline Clinical Sciences Collaborations Consolidated Framework for Implementation Research Cues Data Decision Making Detection Development Education Effectiveness Elderly Emergency Department Physician Emergency Medicine Emergency department visit Ensure Evidence based intervention Evidence based practice Expenditure Exposure to Failure Feedback Goals Guidelines Health Hospitalization Hour Incidence Independent Living Injury Intervention Interview Intuition Judgment Laboratories Link Literature Maintenance Medical Medicare claim Medicine Methods Morbidity - disease rate Pain Paramedical Personnel Participant Patient-Focused Outcomes Patients Pattern Recognition Persons Physicians Play Power Sources Qualitative Evaluations Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Refractory Reporting Research Research Priority Sampling Scientist Source Structure Testing Text Time Training Trauma Trauma patient Triage Uncertainty Variant Video Games Work active control behavior change clinical implementation cognitive process compare effectiveness comparison intervention contextual factors continuing medical education cost effectiveness/implementation study effectiveness/implementation trial experience follow-up future implementation heuristics hospital readmission human old age (65+)implementation efforts implementation science improved improved outcome injury burden insight instrument intervention effect mortality multidisciplinary novel outreach pilot trial pressure preventable death programs provider behavior recruit severe injury theories therapy design trauma centers treatment as usual trial design videogame intervention virtual reality simulation

项目摘要

PROJECT ABSTRACT Injury is the leading cause of loss of independence among those over the age 65, resulting in over 3 million Emergency Department (ED) visits, 800,000 hospitalizations, and greater than $50 billion in costs each year. Guideline-concordant triage of trauma patients – rapid identification of those with severe injuries and transfer to trauma centers – decreases mortality by 10 to 25%, reduces loss of independence, and diminishes pain at one year. Despite this evidence, however, under-triage persists (incidence: 50%), particularly among those over the age of 65 (incidence: 80%). To address this implementation gap, we propose to conduct a Type I hybrid effectiveness-implementation trial in which we test the effect of video game-based training on physician behavior. We designed this trial based on extensive preliminary studies, during which we isolated physician behavior as the single largest source of variation in triage practices, identified heuristics (pattern recognition) as a major cause of behavior, developed theory-based, customized video games to recalibrate physician heuristics (i.e., align them with clinical practice guidelines), and ensured their efficacy in the laboratory. For this trial, we will recruit a national sample of emergency medicine physicians (n=900), in collaboration with three large staffing organizations, and will randomize physicians to one of three interventions: video game-based training, text-based education (active control), or nothing (passive control). The specific aims of the trial are (1) to test the effect of the three interventions on behavioral (e.g., under-triage) and patient-centered outcomes (e.g., 30-day mortality) by linking trial data to Medicare claims, (2) to compare the mechanisms of action by which the active interventions affect physician behavior by using a suite of validated instruments, and (3) to identify contextual factors that influence implementation and maintenance of guidelines in practice by performing a comprehensive qualitative evaluation of trial participants (n=20) and a national sample of key decision makers (e.g., ED directors, patients [n=20/group]). Together these aims will provide critical insight into the effectiveness of our novel intervention and key data to inform future implementation efforts.

项目摘要伤害是 65 岁以上老年人丧失独立性的主要原因，导致超过 300 万人丧失独立能力每年急诊室 (ED) 就诊、80 万人次住院治疗以及超过 500 亿美元的费用。符合指南的创伤患者分诊——快速识别重伤患者并转移至创伤中心 – 将死亡率降低 10% 至 25%，减少独立性丧失，并减轻一次疼痛然而，尽管有这些证据，分类不足的情况仍然存在（发生率：50%），特别是在那些超过 20 岁的人中。 65 岁（发生率：80%）为了解决这一差距实施问题，我们建议进行 I 型混合。有效性实施试验，我们测试基于视频游戏的培训对医生的效果我们根据初步广泛的研究设计了这项试验，在此期间我们隔离了医生。行为作为分类实践中最大的变异来源，识别启发法（模式识别）作为行为的主要原因，开发了基于理论的定制视频游戏来重新校准医生启发式（即，使它们与临床实践指南保持一致），并确保其在实验室中的有效性。试验中，我们将与三个国家合作，招募全国急诊医学医师样本（n = 900）大型人员配置组织，并将随机分配医生进行以下三种干预措施之一：基于视频游戏的干预措施培训、基于文本的教育（主动控制）或什么都不做（被动控制）试验的具体目标是 (1)。测试三种干预措施对行为（例如分类不足）和以患者为中心的结果的影响（例如，30 天死亡率）通过将试验数据与医疗保险索赔联系起来，(2) 比较作用机制积极的干预措施通过使用一套经过验证的仪器来影响医生的行为，以及（3）通过以下方式确定在实践中影响和实施维护指南的背景因素：对试验参与者（n = 20）和关键国家样本进行全面定性评估决策者（例如，急诊科主任、患者 [n=20/组]）将共同提供对这些目标的批判性见解。我们新颖的干预措施和关键数据的有效性，可为未来的实施工作提供信息。