Accelerating Adoption of Comparative Effectiveness Research in Premature Infants

描述（由申请人提供）：我们从现有的比较有效性研究中了解到，某些喂养方法和治疗方法会对早产儿造成整体伤害。我们已经表明，大量的早产儿目前暴露于这些治疗。该提案将改变处方和喂养实践，并在美国出生的25%极低出生体重（<1500 g出生体重）婴儿中测量这些实践变化。这些变化将影响肠内营养（影响所有婴儿）和新生儿重症监护室中12种最常见药物中的6种（抗生素、抗酸剂和类固醇）的使用。我们将使用现有的电子病历，其中包含每年12，000名早产儿的详细医疗保健信息。我们将分两个阶段实施比较有效性研究的结果。第一阶段将包括在质量峰会上对从业人员进行教育，并对电子护理点界面进行更改，其中有针对性地提醒喂养和处方做法，并链接到教育资源。我们的团队将分析来自电子病历的喂养和处方数据，沿着患者层面的人口统计学数据，以确定每个AIM中表现最差的新生儿重症监护病房。然后，我们将对这些表现不佳的单位采取具体的教育干预措施。这项建议将：1）实施从278个新生儿重症监护病房现有的比较有效性研究中制定的当前最佳实践; 2）使用现有的电子病历测试这些实践的依从性; 3）确定符合率超出最佳实践的新生儿重症监护病房;以及4）使用有针对性的干预措施，以进一步改善这些病房采用比较有效性研究的情况。该团队包括国际公认的专家，他们具有使用大型数据库进行比较有效性研究的经验。在过去的10年里，团队成员共同撰写了40篇使用电子病历平台的同行评审文章，这将是该提案的核心。在一系列出版物，质量改进计划和教育计划中，我们已经：1）记录了与危害相关的喂养实践和药物的广泛使用; 2）进行了短期比较有效性项目; 3）改变了美国各地兽医的行为; 4）开发了一个高功能平台来执行拟议的项目。 公共卫生相关性：该提案是学术研究人员，政府和私人执业兽医之间的伙伴关系。我们将开发和测试干预措施，以有效地实施早产儿比较有效性研究的结果。获得有关喂养和处方做法的电子数据，再加上有针对性的教育干预措施，将增加早产儿接触母乳喂养的比例，并减少接触未经证实的药物的比例。

DESCRIPTION (provided by applicant): We know from existing comparative effectiveness research that certain feeding practices and therapeutics result in overall harm to preterm infants. We have shown that a large number of preterm infants are currently exposed to these therapies. This proposal will change prescribing and feeding practices and measure these practice changes in 25% of very low birth weight (<1500 g birth weight) infants born in the US. These changes will influence enteral nutrition (affecting all infants) and the use of 6 of the 12 most common medications (antibiotics, antacids, and steroids) administered in the neonatal intensive care unit. We will use an existing electronic medical record containing detailed healthcare information for 12,000 premature infants a year. We will implement the findings from comparative effectiveness research in 2 phases. The first phase will consist of practitioner education at a Quality Summit and changes to the electronic point-of-care interface with targeted reminders for feeding and prescribing practices and links to educational resources. Our team will analyze feeding and prescribing data from the electronic medical record, along with patient-level data on demographics to identify the worst-performing neonatal intensive care units for each of the AIMs. We will then use specific educational interventions for these poor-performing units. This proposal will: 1) implement current best practices developed from existing comparative effectiveness research across 278 neonatal intensive care units; 2) test compliance with these practices using an existing electronic medical record; 3) identify neonatal intensive care units with compliance rates that fall outside of best practices; and 4) use focused interventions to further improve adoption of comparative effectiveness research at these units. The team includes internationally recognized experts with experience conducting comparative effectiveness research using large databases. In the last 10 years, team members have co-authored 40 peer-reviewed articles using the electronic medical record platform that will be the centerpiece for this proposal. In a series of publications, quality improvement initiatives, and educational programs, we have: 1) documented the widespread use of feeding practices and medications associated with harm; 2) conducted short-term comparative effectiveness projects; 3) changed the behavior of neonatologists throughout the United States; and 4) developed a high-functioning platform to conduct the proposed project. PUBLIC HEALTH RELEVANCE: This proposal is a partnership between academic researchers, government, and private practice neonatologists. We will develop and test interventions to efficiently implement findings from comparative effectiveness research in preterm infants. Access to electronic data regarding feeding and prescribing practices coupled with targeted educational interventions will increase the proportion of preterm infants exposed to human milk feedings and decrease the proportion exposed to unproven medications.