Time-pressured decision making in trauma triage

创伤分类中的时间压力决策

• 批准号: 8475489
• 负责人: Deepika Mohan
• 金额: $ 18.66万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-01 至 2015-05-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8475489
• 关键词: Adherence; Affect; American College of Surgeons; Antitumor Drug Screening Assays; Area; Attitude; Basic Behavioral Science; Basic Behavioral and Social Science Research; Behavior; Behavioral Sciences; Biological Assay; Businesses; Caring; Cell Culture Techniques; Clinical Practice Guideline; Cognitive; Complex; Decision Making; Development; Effectiveness of Interventions; Emergency Situation; Event; Failure; Funding; Future; Goals; Guidelines; Health Knowledge, Attitudes, Practice; Health Services Research; Healthcare; Hospitals; Injury; Intervention; Investments; Judgment; Knowledge; Leadership; Life; Literature; Measures; Medical; Mentors; Methodology; Modeling; Outcome; Patient Care; Patient Transfer; Patients; Pattern; Pennsylvania; Performance; Phase III Clinical Trials; Physicians; Play; Process; Productivity; Relative (related person); Research; Research Personnel; Role; Signal Detection Analysis; Staging; Structure; Surgeon; Technology; Testing; Time; Training; Translating; Trauma; Triage; Universities; Validation; Validity and Reliability; Variant; Work; career development; cost; design; heuristics; improved; injured; insight; medical specialties; meetings; novel; pressure; programs; research study; skills; tool; trauma care; trauma centers

DESCRIPTION (provided by applicant): The overarching goal of my program of research is to improve the care of trauma patients. Trauma disproportionately affects the young and healthy, consuming over $US400 billion annually in direct medical costs and lost productivity. Regionalization, the transfer of moderately to severely injured patients to high level, academic trauma centers, improves outcomes. The American College of Surgeons - Committee on Trauma (ACS-COT) has attempted to improve regionalization by targeting known determinants of behavior: knowledge, attitudes, and organizational constraints. However, physician adherence to the ACS-COT's guidelines for the triage of trauma patients remains less than 60%. Current behavioral science literature suggests that other important determinants of decision making exist, including intuitive judgments (heuristics). The influence of heuristics on trauma triage decision making is unknown. An analysis of physician decision making in trauma triage that uses the insights and methodology of basic behavioral and social sciences research may allow the identification of additional determinants of non-adherence. By providing an explanation for the discrepancy that exists between the ACS-COT's efforts to change physician behavior and current practice patterns, this project holds the potential to alter the current paradigm of quality improvement in trauma. To achieve the goals of this research plan and to establish myself as a leading researcher in health services research related to trauma, I require further training in the following areas: 1) the theoretical constructs underlying physician decisio making; 2) the methodological tools necessary to conduct rigorous, sophisticated research in physician decision making, and 3) the management and leadership skills necessary to transition into an independent investigator. Under the guidance of my mentors, I have devised the didactic and research plan described in the following pages. Together, they will provide the necessary knowledge and skills to conduct cutting-edge, multi-disciplinary research that translates insights from behavioral science into an applied strategy to modify physician adherence to national trauma triage guidelines. The proposed research involves three inter-related studies. Aim 1 will refine a tool, developed in preliminary work, to study physician triage decisions under experimental conditions. Aim 2 will differentiate between the influence of faulty heuristics and knowledge deficits on physician triage decisions. Aim 3 will develop a novel intervention that targets either heuristics or knowledge deficits to help physicians make better triage decisions. These experiments set the stage for future work to test the effectiveness of the intervention in an R01-funded multi-center observational trial. I believe this investment in my career development will contribute to a new understanding of physician decision making in trauma, may improve the care provided to trauma patients, and has the potential to catalyze a change in our approach to quality improvement in health care.

描述（由申请人提供）：我的研究计划的首要目标是改善创伤患者的护理。创伤不成比例地影响年轻人和健康人，每年消耗超过4000亿美元的直接医疗费用和生产力损失。区域化，将中度至重度受伤的患者转移到高水平的学术创伤中心，改善了结果。美国外科医师学会创伤委员会（ACS-COT）试图通过针对已知的行为决定因素（知识、态度和组织约束）来改善区域化。然而，医生遵守ACS-COT的创伤患者分类指南仍然不到60%。目前的行为科学文献表明，决策的其他重要决定因素存在，包括直觉判断（直觉）。创伤分类对创伤分类决策的影响尚不清楚。使用基本行为和社会科学研究的见解和方法，对创伤分诊中的医生决策进行分析，可能会发现其他不依从的决定因素。通过对ACS-COT改变医生行为的努力与当前实践模式之间存在的差异进行解释，该项目有可能改变当前创伤质量改善的范式。为了实现本研究计划的目标，并使自己成为与创伤相关的卫生服务研究的主要研究者，我需要在以下方面进一步培训：1）医生决策的理论结构; 2）在医生决策中进行严格、复杂研究所需的方法学工具，以及3）过渡到独立调查员所需的管理和领导技能。在导师的指导下，我设计了以下几页所述的教学和研究计划。他们将共同提供必要的知识和技能，进行尖端的，多学科的研究，将行为科学的见解转化为应用策略，以修改医生遵守国家创伤分诊指南。本研究涉及三个相互关联的研究。目标1将完善一个工具，在初步工作中开发，在实验条件下研究医生分诊决策。目标2将区分错误的药物分类和知识缺陷对医生分诊决策的影响。目标3将开发一种新的干预措施，以药物学或知识缺陷为目标，帮助医生做出更好的分诊决策。这些实验为未来的工作奠定了基础，以在R 01资助的多中心观察性试验中测试干预措施的有效性。我相信，对我职业发展的这种投资将有助于对医生创伤决策的新理解，可能会改善为创伤患者提供的护理，并有可能催化我们提高医疗保健质量方法的改变。