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Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertig

良性阵发性位置性眩晕循证实践的实施

基本信息

批准号：
8576151
负责人：
Kevin Anthony Kerber
金额：
$ 57.44万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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 2018-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8576151
关键词：
Academy Accident and Emergency department Adult Affect American Behavior Therapy Behavioral Behavioral Sciences Benign Benign paroxysmal positional vertigo Caring Clinical Clinical Management Clinical Trials Design Communities Data Decision Aid Development Diagnosis Disease Distress Dizziness Effectiveness Emergency Medicine Enrollment Evaluation Evidence based practice Exposure to Future Goals Guidelines Head Head and Neck Surgery Head and neck structure Health Services Research Healthcare Hour Image International Interruption Intervention Knowledge Label Laboratories Labyrinth Lead Length of Stay Medical Medicine Mentored Patient-Oriented Research Career Development Award Methods Multimedia Neurologist Neurology Online Systems Otolaryngologist Otolaryngology Outcome Outpatients Patient Care Patients Pattern Peripheral Physicians Plant Roots Population Prevalence Process Provider Publishing Randomized Randomized Controlled Trials Recording of previous events Research Research Personnel Scientist Sick Leave Specialist Surveys Symptoms Testing Vertigo Visit Work X-Ray Computed Tomography base clinical care clinical practice cost design evidence base evidence based guidelines improved innovation particle point of care population based post intervention public health relevance randomized trial routine care routine practice secondary outcome stem theories tool trial comparing

项目摘要

DESCRIPTION (provided by applicant): A wide gap exists between the evidence-base for processes to diagnose and treat Benign Paroxysmal Positional Vertigo (BPPV) and the use of these processes in real world medicine. The proposed research seeks to narrow this gap by implementing a multi-faceted implementation strategy. BPPV is the most common peripheral vestibular disorder and causes disabling symptoms. The disorder stems from free-floating particles that enter a semi-circular canal ("canaliths") of the inner ear. BPPV is diagnosed using a simple and reliable positional test, the Dix-Hallpike test (DHT). The treatment, the Canalith Repositioning Maneuver (CRM), is performed in minutes at the bedside. BPPV patients randomized to the CRM have a cure rate of 80% at 24 hours compared with only 10% of patients randomized to a sham maneuver. However, these guideline supported processes (guidelines published by the American Academy of Otolaryngology-Head and Neck Survey and the American Academy of Neurology) have not adequately disseminated into routine practice. The underuse of these processes has been demonstrated in several different settings. Preliminary results from a population-based study of emergency departments (ED) have found that, among dizziness presentations, the DHT was performed in 3.9% (137 of 3,525) and the CRM in 0.2% (8 of 3,525). Among patients diagnosed with BPPV by the treating physician, 78% did not have the DHT and 96.1% did not have a CRM. In fact, other tests (e.g., head CT scans) and treatments (e.g., medicines) are more commonly utilized in ED patients diagnosed with BPPV - a finding that further highlights inefficiencies. ED providers have ranked the topic of vertigo as the #1 priority for decision support development for adult patients. Additional preliminary data from the investigators indicates high demand among ED physicians for management support specifically for BPPV. The goal of this project is to implement BPPV processes in the ED. The central hypothesis is that a multi-faceted strategy will increase the use of BPPV processes. In specific aim 1 of the project, the investigators will develop a theory-based, multi-faceted BPPV behavioral and educational strategy (including a web-based multimedia point of care clinical tool). In specific aim 2, a randomized controlled trial will be ued to test the effect of a decision aid on guideline concordant practice patterns and BPPV knowledge using a previously validated method of vignette-based research. In specific aim 3, the investigators will implement and evaluate, in a community ED setting, the effect of the implementation strategy on the use of BPPV processes using a staggered enrollment randomized trial design. Exploratory outcomes include ED efficiencies and cost of care. For this project, an outstanding trans-disciplinary team has been assembled (neurologists, otolaryngologists, community and academic emergency medicine physicians, behavioral scientists, implementation specialists, cost analyst, and technical developers). Collectively, the team has extensive content expertise across multiple domains and a history of successful behavioral intervention projects.

描述（由申请人提供）：诊断和治疗良性阵发性位置性眩晕（BPPV）的过程的证据基础与这些过程在真实的世界医学中的使用之间存在很大差距。拟议的研究旨在通过实施多方面的实施策略来缩小这一差距。BPPV是最常见的外周前庭疾病，并导致致残症状。这种疾病源于自由漂浮的颗粒进入内耳的半圆形通道（“耳道”）。BPPV的诊断使用一个简单而可靠的位置测试，Dix-Hallpike测试（DHT）。治疗，Canalith复位手法（CRM），是在几分钟内在床边进行。随机分配到CRM组的BPPV患者在24小时的治愈率为80%，而随机分配到假手术组的患者仅为10%。然而，这些指南支持的过程（由美国耳鼻咽喉头颈部调查学会和美国神经病学学会发布的指南）尚未充分传播到常规实践中。在几种不同的情况下，这些程序都没有得到充分利用。一项基于人群的急诊科（艾德）研究的初步结果发现，在头晕表现中，3.9%（137/3525）进行了DHT，0.2%（8/3525）进行了CRM。在治疗医生诊断为BPPV的患者中，78%没有DHT，96.1%没有CRM。事实上，其他测试（例如，头部CT扫描）和治疗（例如，药物）更常用于诊断为BPPV的艾德患者-这一发现进一步突出了效率低下。艾德提供者将眩晕主题列为成人患者决策支持开发的首要任务。来自研究者的额外初步数据表明，艾德医生对BPPV管理支持的需求很高。本项目的目标是在教育部实施BPPV流程。中心假设是，多方面的战略将增加BPPV流程的使用。在该项目的具体目标1中，研究人员将开发一种基于理论的，多方面的BPPV行为和教育策略（包括基于网络的多媒体护理临床工具）。在具体目标2中，将使用一项随机对照试验，使用先前验证的基于插图的研究方法，测试决策辅助对指南一致性实践模式和BPPV知识的影响。在具体目标3中，研究者将在社区艾德环境中实施并评价实施策略对使用交错入组随机试验设计的BPPV过程的影响。探索性结局包括艾德效率和护理成本。为了这个项目，已经组建了一支优秀的跨学科团队（神经科医生，耳鼻喉科医生，社区和学术急诊医学医生，行为科学家，实施专家，成本分析师和技术开发人员）。总的来说，该团队在多个领域拥有广泛的内容专业知识和成功的行为干预项目的历史。