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DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project

通过实施治疗头晕

基本信息

批准号：
10471884
负责人：
Kevin Anthony Kerber
金额：
$ 63.78万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10471884
关键词：
Accident and Emergency department Acute Admission activity Adverse event Benign paroxysmal positional vertigo California Caring Clinical Diagnosis Disease Dizziness Education Educational Materials Emergency department visit Equipment and supply inventories Evidence based practice Exposure to Frequencies Guidelines Head Hybrids Incentives Individual Intervention Interview Length of Stay Measures Medicine Nurses Outcome Patient-Focused Outcomes Patients Performance Peripheral Persons Play Process Provider Randomized Randomized Clinical Trials Reminder Systems Reporting Research Personnel Resources Role Safety Site Stroke Structure Testing Vestibular Neuronitis Visit Walking base design disability disabling symptom dissemination strategy effectiveness evaluation effectiveness implementation trial evidence base experience follow-up gaze implementation evaluation implementation fidelity implementation outcomes implementation research implementation strategy improved innovation patient oriented post intervention primary outcome programs randomized trial routine provider scale up stroke risk

项目摘要

Project Summary/ Abstract Dizziness in the emergency department (ED) is a common problem with many opportunities to implement efficient and evidenced-based practices. In DIZZTINCT-1, we developed and evaluated an implementation strategy that focused on increasing the performance of the Dix-Hallpike test (DHT) and canalith repositioning maneuver (CRM) in the ED by applying a benign paroxysmal positional vertigo (BPPV) -centric approach. We found that the strategy substantially increased DHT and CRM performance. In implementation fidelity interviews, providers who started using the DHT and CRM typically reported positive experiences, as reflect by the following quote: “He immediately felt better and walked out about 20 minutes later…it was awesome.” There was also a decrease in the use of head CTs, which are typically unnecessary with a BPPV-centric approach. Importantly, the decrease in head CTs did not lead to an increase in stroke misdiagnosis. DIZZTINCT-1, however, is limited in its potential to scale-up because it used investigator led education sessions, cash incentives, and did not have adequate engagement at nonacademic facilities. We learned about important revisions to the strategy that could increase generalizability and more routine provider use, particularly at nonacademic EDs. In DIZZTINCT-2, we will enhance and refine the strategy in four ways. First, the education sessions will be more generalizable because we will utilize local providers and an online CME program. Second, we will broaden the target providers to include nurses since we learned that nurses can play a major role in implementing the BPPV-centric approach. Third, we will respond to provider requests to expand the topic to include best practices for assessing stroke risk in dizziness visits and evidence-based diagnosis & management for vestibular neuritis. Expanding the topic could both increase exposures to the BPPV-centric resources and create more opportunities for best practices. Fourth, we will add patient-oriented resources, which also responds to providers’ requests and increases opportunities for best management. For DIZZTINCT- 2, we have partnered with Kaiser Permanente Southern California (KPSC) to test the strategy. KPSC has 12 EDs and ~40,000 annual dizziness visits. DIZZTINCT-2 will use a hybrid type 3 implementation-effectiveness trial of a stepped wedge randomized trial for the ED implementation strategy and an embedded randomized patient-level dissemination strategy. We have the following specific aims: Aim 1. To determine the impact of the revised and enhanced BPPV-centric implementation strategy on DHT/CRM performance in dizziness visits, at academic and nonacademic EDs, using a randomized stepped wedge design. Aim 2. To evaluate clinical outcomes associated with the implementation strategy using both a stepped wedge ED-level strategy and an embedded randomized clinical trial of a patient-level dissemination strategy. DIZZTINCT-2 is the first study to apply and evaluate a broad strategy to enhance optimal care in dizziness visits, to focus on nonacademic EDs, and to measure both implementation and patient outcomes.

项目概要/摘要急诊科 (ED) 头晕是一个常见问题，有很多实施机会有效且基于证据的实践。在 DIZZTINCT-1 中，我们开发并评估了一个实现专注于提高 Dix-Hallpike 测试 (DHT) 和耳道重新定位性能的策略通过应用良性阵发性位置性眩晕（BPPV）为中心的方法在急诊室进行机动（CRM）。我们发现该策略显着提高了 DHT 和 CRM 性能。在实施保真度在采访中，开始使用 DHT 和 CRM 的提供商通常会报告积极的体验，如 the following quote: “He immediately felt better and walked out about 20 minutes later…it was awesome.” 头部 CT 的使用也有所减少，而以 BPPV 为中心的患者通常不需要头部 CT 方法。重要的是，头部 CT 的减少并没有导致中风误诊的增加。然而，DIZZTINCT-1 的扩大规模潜力有限，因为它使用了研究者主导的教育会议、现金奖励，并且在非学术设施中没有充分的参与。我们学到了关于对战略进行重要修订，以提高普遍性和更常规的提供者使用，特别是在非学术性的 ED 中。在 DIZZTINCT-2 中，我们将从四个方面增强和完善策略。第一的，教育课程将更加普遍，因为我们将利用当地提供者和在线 CME 程序。其次，我们将扩大目标提供者以包括护士，因为我们了解到护士可以玩在实施以 BPPV 为中心的方法中发挥着重要作用。第三，我们将响应提供商的扩展请求该主题包括在头晕就诊和循证诊断中评估中风风险的最佳实践& 前庭神经炎的治疗。扩大主题可以增加以 BPPV 为中心的曝光度资源并为最佳实践创造更多机会。第四，我们会增加以患者为中心的资源，这也满足了提供商的要求并增加了最佳管理的机会。对于 DIZZTINCT- 2、我们与南加州凯撒医疗机构 (KPSC) 合作测试该策略。 KPSC 有 12 急诊室和每年约 40,000 次头晕就诊。 DIZZTINCT-2 将使用混合类型 3 实施有效性 ED 实施策略的阶梯楔形随机试验和嵌入式随机试验患者层面的传播策略。我们有以下具体目标：目标 1. 确定修订和增强了以 BPPV 为中心的 DHT/CRM 在头晕就诊中的表现实施策略，在学术和非学术 ED，使用随机阶梯楔形设计。目标 2. 评估临床与使用阶梯楔形 ED 级策略和患者层面传播策略的嵌入式随机临床试验。 DIZZTINCT-2 是第一项研究应用和评估广泛的策略，以加强头晕就诊时的最佳护理，重点关注非学术性急诊室，并衡量实施情况和患者结果。