De-Implementation of Low Value Imaging in Pulmonary Embolism (DELVE PE)
肺栓塞低价值成像的取消实施 (DELVE PE)
基本信息
- 批准号:10302031
- 负责人:
- 金额:$ 17.43万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-09-01 至 2026-07-31
- 项目状态:未结题
- 来源:
- 关键词:Accident and Emergency departmentAddressAdministratorAdvisory CommitteesAlgorithmsAmericanAmerican College of RadiologyAnaphylaxisAngiographyAreaBehaviorBeliefBenchmarkingCaringChestClinicalClinical Oncology Supplement (K12)CommunitiesDataDeimplementationDepartment chairDevelopment PlansDyesEffectivenessElectronic Health RecordElementsEmergency Department PhysicianEmergency MedicineEmergency department visitEmotionsEnsureEvaluationEvidence based practiceFeedbackFoundationsFrightGoalsGuidelinesHealth systemImageInformaticsInstitutionInterventionInterviewInvestigationIonizing radiationK-Series Research Career ProgramsKnowledgeLearning ModuleLungMassachusettsMentored Patient-Oriented Research Career Development AwardMentorsMethodologyMethodsMulticenter TrialsNational Heart, Lung, and Blood InstitutePatient CarePatientsPeer PressurePerformancePhysiciansPilot ProjectsPositioning AttributeProviderPulmonary EmbolismReportingResearchResearch PersonnelRiskSafetySocietiesStructureSurveysTechnical ExpertiseTestingTrainingUnited StatesWorkX-Ray Computed Tomographybasebehavior changecareer developmentclinical decision supportcognitive testingcollegecostdesignevidence baseexperienceimaging studyimplementation barriersimplementation facilitatorsimplementation frameworkimplementation scienceimplementation strategyimprovedinnovationinsightlung imagingnovelorganizational climateovertreatmentpodcastpractice settingprototypeprovider behaviorradiation riskrisk stratificationsocialsuccesstheoriestomographytooltrial designusabilityuser centered design
项目摘要
1 PROJECT SUMMARY
2 Two percent (2%) of all 120 million annual emergency department (ED) visits in the United States undergo computed
3 tomographic pulmonary angiography (CTPA) for pulmonary embolism (PE) every year. However, many of these are
4 avoidable. Unnecessary testing subjects patients to additional costs, ionizing radiation, and risk of anaphylaxis from contrast
5 media. Further, because false positive CTPAs are common (estimated at 5-26%), overdiagnosis and overtreatment are
6 growing problems in the United States. Despite guidelines recommending the reduction of low-value imaging for PE, the
7 volume of unnecessary imaging studies for PE in US EDs continues to rise, exposing patients to harm from overtesting and
8 overdiagnosis. Prior strategies have attempted to close this knowledge-practice quality gap but only had modest success,
9 possibly because changing provider behavior is challenging and most initiatives focused on isolated strategies. We propose
10 to develop, pilot, and evaluate a multi-dimensional `enhanced' audit-feedback strategy (EAF) to de-implement low-value
11 imaging in PE. The core strategy, audit-feedback, was chosen to target drivers of low-value imaging in PE discovered in
12 our foundational work: knowledge, peer pressure, emotion, and belief about consequences. We designed the strategy using
13 a novel audit-feedback theory, the Clinical Performance Feedback Intervention Theory (CP-FIT). The audit-feedback is
14 `enhanced' by complementary strategies to assist in action planning and empower clinicians to change their behavior. This
15 includes an aid for appropriate testing that guides clinicians through an unambiguous algorithm for evaluation of PE, an
16 educational podcast, and local champions. In Aim 1, we will develop, refine, and operationalize the de-implementation
17 strategy components. We will conduct cognitive testing of the prototypes of the audit-feedback reports, develop an
18 electronic health record (EHR)-integrated aid, record the educational podcast, and identify and train local champions. In
19 Aim 2, we will pilot alternative versions of the EAF strategy in 5 EDs to evaluate acceptability and appropriateness. We
20 will alter the delivery of the components of feedback (local champion versus departmental chair), educational podcast (with
21 or without a real patient narrative), and the aid for appropriate testing (static versus EHR-integrated aid) to ascertain the
22 acceptability, appropriateness, and added value of these iterations. We will pilot different versions of the strategy to evaluate
23 aspects of CP-FIT including complexity, social influence, and actionability, which CP-FIT suggests drive the audit-feedback
24 cycle and, ultimately, behavior change. We will use mixed methods to evaluate the strategy and select a refined strategy for
25 a multi-center trial. In this K23 application, we have proposed a detailed career development plan in which I will gain
26 methodological and technical expertise in advanced implementation science strategies, methods, and trial design. I am well
27 supported by an experienced team of mentors and advisors. At the end of this mentored career development award, I will
28 have a robust empirically-derived and theory-informed strategy and will be positioned to test this strategy in a multi-center
29 trial as an independent investigator.
30
1项目总结
项目成果
期刊论文数量(0)
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Lauren Westafer其他文献
Lauren Westafer的其他文献
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{{ truncateString('Lauren Westafer', 18)}}的其他基金
De-Implementation of Low Value Imaging in Pulmonary Embolism (DELVE PE)
肺栓塞低价值成像的取消实施 (DELVE PE)
- 批准号:
10685285 - 财政年份:2021
- 资助金额:
$ 17.43万 - 项目类别:
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