Sustainable deimplementation of continuous pulse oximetry monitoring in children hospitalized with bronchiolitis: study protocol for the Eliminating Monitor Overuse (EMO) type III effectiveness-deimplementation cluster-randomized trial.
Sustainable deimplementation of continuous pulse oximetry monitoring in children hospitalized with bronchiolitis: study protocol for the Eliminating Monitor Overuse (EMO) type III effectiveness-deimplementation cluster-randomized trial.
复制标题
DOI：
10.1186/s13012-022-01246-z
复制
发表时间：
2022-10-21
影响因子：
7.2
通讯作者：
Beidas, Rinad S.
中科院分区：
文献类型：
--
作者：
Bonafide, Christopher P.;Xiao, Rui;Schondelmeyer, Amanda C.;Pettit, Amy R.;Brady, Patrick W.;Landrigan, Christopher P.;Wolk, Courtney Benjamin;Cidav, Zuleyha;Ruppel, Halley;Muthu, Naveen;Williams, Nathaniel J.;Schisterman, Enrique;Brent, Canita R.;Albanowski, Kimberly;Beidas, Rinad S.
对维持停止使用过度的医疗做法（即没有证据支持的做法）的方法研究不足。在儿科医院医学中，只有在特定情况下才建议对患有常见病毒性呼吸道疾病毛细支气管炎的儿童进行连续脉搏血氧仪监测。三个国家指导方针不鼓励没有接受补充氧气的儿童使用它，但与指导方针不一致的做法（即过度使用）仍然普遍存在。在6家医院试行了一项带有审计和反馈的教育外展活动，结果立即减少了过度使用；然而，最佳的策略，以优化维持废执行成功是未知的。消除监测过度使用（EMO）试验将在混合型III有效性-取消实施试验中比较两种取消实施策略。这项纵向集群随机设计将在住院儿科研究（PRIS）网络医院进行，包括基线测量、主动取消实施和维持阶段。在基线测量期之后，16-19家医院将被随机分配到以放弃学习为目标的去实施战略（带有审计和反馈的教育推广），另外16-19家医院将被随机分配到以放弃学习和替代为目标的战略（增加ehr整合的临床路径决策支持工具）。主要结果是未接受任何补充氧气的毛细支气管炎患者的脱氧维持，作为研究组间过度使用率的纵向差异比较进行分析。次要结果包括取消执行的公平性、对每个取消执行策略的忠实度和成本。为了理解去执行策略是如何起作用的，我们将测试常规化（临床医生开发支持实践变化的新常规）和制度化（将实践变化嵌入现有组织系统）的假设机制。EMO试验将通过提供对流程、机制、成本和使用严格设计的废除策略持续改变实践的可能性的新见解，推进废除实施科学。该试验还将推进对一种高发病率、昂贵的儿科肺病的治疗。ClinicalTrials.gov NCT05132322。于2021年11月10日注册。在线版本包含补充资料，网址为10.1186/s13012-022-01246-z。
Methods of sustaining the deimplementation of overused medical practices (i.e., practices not supported by evidence) are understudied. In pediatric hospital medicine, continuous pulse oximetry monitoring of children with the common viral respiratory illness bronchiolitis is recommended only under specific circumstances. Three national guidelines discourage its use for children who are not receiving supplemental oxygen, but guideline-discordant practice (i.e., overuse) remains prevalent. A 6-hospital pilot of educational outreach with audit and feedback resulted in immediate reductions in overuse; however, the best strategies to optimize sustainment of deimplementation success are unknown. The Eliminating Monitor Overuse (EMO) trial will compare two deimplementation strategies in a hybrid type III effectiveness-deimplementation trial. This longitudinal cluster-randomized design will be conducted in Pediatric Research in Inpatient Settings (PRIS) Network hospitals and will include baseline measurement, active deimplementation, and sustainment phases. After a baseline measurement period, 16–19 hospitals will be randomized to a deimplementation strategy that targets unlearning (educational outreach with audit and feedback), and the other 16–19 will be randomized to a strategy that targets unlearning and substitution (adding an EHR-integrated clinical pathway decision support tool). The primary outcome is the sustainment of deimplementation in bronchiolitis patients who are not receiving any supplemental oxygen, analyzed as a longitudinal difference-in-differences comparison of overuse rates across study arms. Secondary outcomes include equity of deimplementation and the fidelity to, and cost of, each deimplementation strategy. To understand how the deimplementation strategies work, we will test hypothesized mechanisms of routinization (clinicians developing new routines supporting practice change) and institutionalization (embedding of practice change into existing organizational systems). The EMO trial will advance the science of deimplementation by providing new insights into the processes, mechanisms, costs, and likelihood of sustained practice change using rigorously designed deimplementation strategies. The trial will also advance care for a high-incidence, costly pediatric lung disease. ClinicalTrials.gov,NCT05132322. Registered on November 10, 2021. The online version contains supplementary material available at 10.1186/s13012-022-01246-z.
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
5.9
作者：
Glisson, Charles;Williams, Nathaniel J.;Green, Philip
通讯作者：
Green, Philip
影响因子：
8
作者：
Biondi, Eric A.;McCulloh, Russell;Ralston, Shawn L.
通讯作者：
Ralston, Shawn L.
影响因子：
7.4
作者：
Croskerry, Pat
通讯作者：
Croskerry, Pat
影响因子：
5.4
作者：
Grimshaw, Jeremy M.;Patey, Andrea M.;Bhatia, R. Sacha
通讯作者：
Bhatia, R. Sacha