Outcomes after a Digital Behavior Change Intervention to Improve Trauma Triage: An Analysis of Medicare Claims.
Outcomes after a Digital Behavior Change Intervention to Improve Trauma Triage: An Analysis of Medicare Claims.
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DOI：
10.1016/j.jss.2021.07.029
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Barnato AE
中科院分区：
文献类型：
--
作者：
Mohan D;Chang CC;Fischhoff B;Rosengart MR;Angus DC;Yealy DM;Barnato AE
创伤分类不足仍然很普遍，部分原因是非创伤中心的医生做出的决定。我们开发了两种数字行为改变干预措施，以重新校准医生的行为学（模式识别），并将688名急诊医生随机分配使用干预措施或对照。在这项观察性随访中，我们评估了干预措施是否会改变医生在实践中的表现。我们获得了2016-2018年严重受伤患者的医疗保险索赔，将试验参与者的姓名与国家提供者标识符（NPI）联系起来，并确定了试验参与者在试验前后一年内向非创伤中心提交的受伤患者索赔。主要的结局指标是严重受伤患者的分诊状态。我们将670名（97%）参与者与NPI联系起来，确定了520名（76%）参与者为严重受伤患者提出的索赔，以及228名（33%）在非创伤中心提出的索赔。大多数参与者是白色（64%），男性（67%），并有三年以上的经验（91%）。患者的中位损伤严重度评分为16（IQR 16-17），主要是持续性神经创伤。调整后，随机分配到干预组的医生治疗的患者在试验后一年的分诊不足率低于试验前（41% v. 58% [−17%]，p=0.015）;随机分配到对照组的医生治疗的患者在分诊不足率方面没有差异（49% v. 56% [−7%]，p=0.35）。差异中的差异不显著（10%，p=0.18）。跟踪试验参与者在国家索赔中的表现是可行的。样本量的限制限制了对干预效果的因果推断。
Under-triage in trauma remains prevalent, in part because of decisions made by physicians at non-trauma centers. We developed two digital behavior change interventions to recalibrate physician heuristics (pattern recognition), and randomized 688 emergency medicine physicians to use the interventions or to a control. In this observational follow-up, we evaluated whether exposure to the interventions changed physician performance in practice. We obtained 2016–2018 Medicare claims for severely injured patients, linked the names of trial participants to National Provider Identifiers (NPIs), and identified claims filed by trial participants for injured patients presenting to non-trauma centers in the year before and after their trial. The primary outcome measure was the triage status of severely injured patients. We linked 670 (97%) participants to NPIs, identified claims filed for severely injured patients by 520 (76%) participants, and claims filed at non-trauma centers by 228 (33%). Most participants were white (64%), male (67%), and had more than three years of experience (91%). Patients had a median Injury Severity Score of 16 (IQR 16–17), and primarily sustained neurotrauma. After adjustment, patients treated by physicians randomized to the interventions experienced less under-triage in the year after the trial than before (41% v. 58% [−17%], p=0.015); patients treated by physicians randomized to the control experienced no difference in under-triage (49% v. 56% [−7%], p=0.35). The difference-in-the-difference was non-significant (10%, p=0.18). It was feasible to track trial participants’ performance in national claims. Sample size limitations constrained causal inference about the effect of the interventions.
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DOI：
10.1136/bmj.j5416
发表时间：
2017-12-12
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Mohan D;Farris C;Fischhoff B;Rosengart MR;Angus DC;Yealy DM;Wallace DJ;Barnato AE
通讯作者：
Barnato AE
影响因子：
3.7
作者：
Greene, Nathaniel H.;Kernic, Mary A.;Rivara, Frederick P.
通讯作者：
Rivara, Frederick P.
影响因子：
--
作者：
Chang, David C.;Bass, Robert R.;MacKenzie, Ellen J.
通讯作者：
MacKenzie, Ellen J.
影响因子：
--
作者：
Mohan, Deepika;Rosengart, Matthew R.;Barnato, Amber E.
通讯作者：
Barnato, Amber E.
影响因子：
158.5
作者：
Bhasin, Shalender;Gill, Thomas M.;Peduzzi, Peter
通讯作者：
Peduzzi, Peter