The ROUTT-B (Reduce Over-Utilized Tests and Treatments in Bronchiolitis) Study: Developing a Roadmap for De-Implementation

项目总结 这项建议的首要目标是将毛细支气管炎作为病例研究，以促进疾病的科学研究。 通过确定减少过度检测和过度治疗的战略和流程来实施 毛细支气管炎，以后可以广泛适应不同的环境和疾病过程。中国面临的挑战 毛细支气管炎是提供高质量的、以证据为基础的护理需要“少即是多”的方法，因为非 大多数住院患者接受的推荐的、过时的和可能有害的测试和治疗 没有替代者。因此，毛细支气管炎是住院的最常见原因 婴儿，是研究去执行的理想条件。 在她的一系列项目中，泰勒博士提出了传播和 执行(D&I)科学解决了非执行的独特问题。在学习型卫生系统内 泰勒博士将使用PRISM D&I模型作为指导：1)使用定性方法来定义 从医疗保健提供者的角度影响毛细支气管炎过度使用的背景因素， 家长和医疗保健组织，2)制定一套务实、可行和有效的解除实施 毛细支气管炎战略，包括指导如何使战略适应当地情况；以及3) 进行试点研究，以确定取消执行的可行性、可接受性和取消执行的有效性 实施战略。作为对促进过度使用或使能的语境因素的首批探索之一 成功取消实施，预计这项研究将产生与取消执行相关的宝贵知识 在疾病和医疗保健环境中实施。这一结果将为大范围、大范围、大范围的 务实、随机对照的去执行策略试验使无效和潜在的 有害的医疗行为减少了。 申请者艾米·泰勒，医学博士，MSCS博士，为完成拟议的研究做好了出色的准备，给出了 她过去的训练和经验。在这一经验的基础上，为她的长期职业生涯取得进展 目标，泰勒博士寻求利用这个职业发展奖来实现调查的独立性和 促进对有效和可推广的潜在取消实施方法的科学理解 有害的测试和治疗。这项工作将促进儿科护理指南的一致性、高质量、急诊护理 病人，AHRQ优先考虑的人群。泰勒博士组建了一支国际公认的导师团队 拥有与她在传播和实施科学(D&I)方面的培训目标直接相关的专业知识(Dr. 邓普西博士和格拉斯哥博士)、定性研究(邓普西博士和霍尔特罗普博士)和实用的临床试验(邓普西博士和霍尔特洛普博士)。 邓普西和格拉斯哥)。她将在合作环境中进行拟议的研究 由成人和儿童健康联盟支持的科罗拉多大学安舒茨医学院 结果研究和交付科学D&I科学和结果研究核心。

PROJECT SUMMARY The overarching goal of this proposal is to use bronchiolitis as a case study to advance the science of de- implementation by identifying strategies and processes for reducing over-testing and over-treatment in bronchiolitis that can later be broadly adapted to varied contexts and disease processes. The challenge in bronchiolitis is that providing high-quality, evidenced-based care requires a “less is more” approach as the non- recommended, outdated, and potentially harmful tests and treatments that most admitted patients receive do not have replacements. Therefore, bronchiolitis which is the most common cause of hospitalization among infants, is an ideal condition to study de-implementation. In her set of projects, Dr. Tyler proposes the innovative application of dissemination and implementation (D&I) science to the unique problem of de-implementation. Within a learning health system called PEDSnet, Dr. Tyler will use the PRISM D&I model as a guide to: 1) use qualitative methods to define contextual factors influencing over-utilization in bronchiolitis from the perspective of healthcare providers, parents, and healthcare organizations, 2) develop a set of pragmatic, feasible, and effective de-implementation strategies for bronchiolitis that includes guidance on how to adapt the strategies to local contexts, and 3) conduct a pilot study to determine the feasibility, acceptability, and de-implementation effectiveness of the de- implementation strategies. As one of the first explorations of contextual factors fostering overuse or enabling successful de-implementation, this study is expected to generate valuable knowledge relevant to de- implementation across diseases and healthcare settings. The results will provide pilot data for a large-scale, pragmatic, randomized-controlled trial of the de-implementation strategies so that ineffective and potentially harmful medical practices are reduced. The applicant, Amy Tyler, MD, MSCS is excellently prepared to complete the proposed research, given her past training and experience. To build upon this experience and progress toward her long-term career goals, Dr. Tyler seeks to use this career development award to achieve investigative independence and advance scientific understanding of effective and generalizable methods for de-implementing potentially harmful tests and treatments. This work will promote guideline concordant, high quality, acute care for pediatric patients, an AHRQ priority population. Dr. Tyler has assembled an internationally-recognized mentorship team with expertise directly related to her training goals in dissemination and implementation science (D&I) (Drs. Dempsey and Glasgow), qualitative research (Drs. Dempsey and Holtrop), and pragmatic clinical trials (Drs. Dempsey and Glasgow). She will conduct the proposed research in the collaborative environment of the University of Colorado Anschutz Medical Campus supported by the Adult and Child Consortium for Health Outcomes Research and Delivery Science D&I Science and Outcomes Research Cores.