Optimizing Implementation of Multiplex Molecular Panel Testing to Reduce Diagnostic Error

优化多重分子面板测试的实施以减少诊断错误

• 批准号: 10428966
• 负责人: Jonathan Baghdadi
• 金额: $ 14.72万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10428966
• 关键词: Optimizing; Implementation; Multiplex; Molecular; Panel

Respiratory and gastrointestinal complaints are among the most common reasons why adults are prescribed antibiotics in acute care. In recent years, multiplex molecular panels that rapidly test for 15-25 for pathogens simultaneously, including bacteria and viruses, have entered common use and dramatically changed clinicians’ basic approach to these conditions. The potential advantage of multiplex panels is that, if uses properly, rapid diagnosis may facilitate targeted antibiotic or antiviral therapy. But multiplex panels are “shotgun” tests that frequently produce false positives. When implemented without consideration of unintended consequences, their use can either have no impact or lead to inappropriate antibiotics. This study will address a gap in the literature by identifying when multiplex panel tests can change clinical management or benefit the patient and designing interventions to nudge testing in those situations. The proposed studies will promote patient safety and reduce misdiagnosis through diagnostic stewardship, an emerging model for infectious diseases care that uses “nudge” interventions to encourage evidence-based testing. Aim 1 will define high- and low-value use of multiplex panel testing by examining clinical outcomes after testing among patients seen in acute care at 200 hospitals contributing to the Premier Healthcare Database. Aim 2 will develop electronic health record-based interventions to nudge better testing practices in acute care based on qualitative input from frontline clinicians. Aim 3 will be a quasi-experimental trial of diagnostic stewardship interventions at two hospitals in the University of Maryland System. Other system hospitals will be concurrent controls. This research will lead to the first large-scale trial evaluating diagnostic stewardship of multiplex molecular panel tests in acute care. I am an infectious disease physician and hospital epidemiologist with a PhD in health services research. My long-term career goal is to become an independent investigator performing health services research to redesign systems of care with a focus on molecular diagnostics for patients with suspected infections. To achieve this goal, I will undergo formal training in molecular microbiology, healthcare informatics, and implementation science. I will be mentored by an interdisciplinary team including Dr. Daniel Morgan, an AHRQ-funded expert in diagnostic stewardship, Dr. J. Kristie Johnson, expert in clinical microbiology, Dr. Sarah Krein, an expert in mixed methods and user-centered design, and Dr. Anthony Harris, an expert in quasi- experimental trials. The long-term scientific goal of my research is to improve antibiotic use through high-quality and high-value diagnostic testing for infectious diseases.

呼吸道和胃肠道不适是成年人 都是在急救中开出的抗生素。近年来，多重分子面板迅速 同时检测15-25种病原体，包括细菌和病毒，已进入 并极大地改变了临床医生对这些疾病的基本方法。这个 多重面板的潜在优势是，如果使用得当，快速诊断可能有助于 有针对性的抗生素或抗病毒治疗。但多路面板是经常进行的“猎枪”测试 产生假阳性。在不考虑意外后果的情况下实施时， 它们的使用要么没有影响，要么导致不适当的抗生素。这项研究将解决一个 通过确定多重小组试验何时可以改变临床管理来填补文献中的空白 或使患者受益，并设计干预措施以推动在这些情况下的测试。 拟议的研究将促进患者的安全，并通过诊断减少误诊 管理，一种新兴的传染病护理模式，使用“轻推”干预措施 鼓励循证测试。目标1将定义多路复用板的高价值和低价值使用 通过检查在200℃的急性护理中看到的患者的测试后的临床结果进行测试 为顶级医疗保健数据库做出贡献的医院。目标2将开发电子健康 以记录为基础的干预措施，以推动更好的检测实践在急性护理基于质量 来自一线临床医生的意见。目标3将是诊断管理的准实验试验 马里兰大学系统中两家医院的干预措施。其他系统医院将 成为并发控制。这项研究将导致评估诊断的第一次大规模试验 急性护理中多重分子面板试验的管理。 我是一名传染病内科医生和医院流行病学家，拥有卫生服务博士学位。 研究。我的长期职业目标是成为一名独立的健康调查员 重新设计护理系统的服务研究，重点是对患者的分子诊断 疑似感染的人。为了实现这个目标，我将接受分子方面的正式培训 微生物学、医疗保健信息学和实施科学。我将由一位 包括丹尼尔·摩根博士在内的跨学科团队，他是AHRQ资助的诊断专家 临床微生物学专家J.Kristie Johnson博士，临床微生物学专家Sarah Krein博士， 混合方法和以用户为中心的设计，以及准 试验性试验。我研究的长期科学目标是改善抗生素的使用 通过高质量和高价值的传染病诊断检测。