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:8706122
- 负责人:
- 金额:$ 61.11万
- 依托单位:
- 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:
- 关键词:AcademyAccident and Emergency departmentAdultAffectAmericanBehavior TherapyBehavioralBehavioral SciencesBenignBenign paroxysmal positional vertigoCaringClinicalClinical ManagementClinical Trials DesignCommunitiesDataDecision AidDevelopmentDiagnosisDiseaseDistressDizzinessEffectivenessEmergency Department PhysicianEmergency Department patientEmergency MedicineEnrollmentEvaluationEvidence based practiceExposure toFutureGoalsGuidelinesHeadHead and Neck SurgeryHead and neck structureHealth Services ResearchHealthcareHourImageInternationalInterruptionInterventionKnowledgeLabelLaboratoriesLabyrinthLeadLength of StayMedicalMedicineMentored Patient-Oriented Research Career Development AwardMethodsMultimediaNeurologistNeurologyOnline SystemsOtolaryngologistOtolaryngologyOutcomeOutpatientsPatient CarePatientsPatternPeripheralPhysiciansPlant RootsPopulationPrevalenceProcessProviderPublishingRandomizedRandomized Controlled TrialsRecording of previous eventsResearchResearch PersonnelScientistSick LeaveSpecialistSurveysSymptomsTestingVertigoVisitWorkX-Ray Computed Tomographybaseclinical careclinical practicecostdesignevidence baseevidence based guidelinesimprovedinnovationparticlepoint of carepopulation basedpost interventionpublic health relevancerandomized trialroutine careroutine practicesecondary outcomestemtheoriestooltrial 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):在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现实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战略来缩小这一差距。BPPV是最常见的外周前庭障碍,可导致致残症状。这种疾病是由自由漂浮的颗粒进入内耳的半圆形管道(“管道”)引起的。BPPV的诊断采用简单可靠的体位检查,即Dix-Hallpike检查(DHT)。治疗,运河重新定位手法(CRM),在床边几分钟内完成。BPPV患者随机分到CRM组,24小时的治愈率为80%,而随机分到假手术组的患者只有10%。然而,这些指南支持的过程(由美国耳鼻喉头颈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。在几个不同的环境中,这些过程的利用不足已得到证明。一项基于人群的急诊科(ED)研究的初步结果发现,在出现头晕症状的患者中,DHT占3.9%(3525人中有137人),CRM占0.2%(3525人中有8人)。在治疗医师诊断为BPPV的患者中,78%没有DHT, 96.1%没有CRM。事实上,其他检查(如头部CT扫描)和治疗(如药物)更常用于诊断为BPPV的ED患者-这一发现进一步突出了效率低下。急诊科医生将眩晕作为成人患者决策支持发展的第一优先事项。来自调查人员的其他初步数据表明,急诊科医生对BPPV管理支持的需求很高。本项目的目标是在ED中实施BPPV流程。中心假设是一个多面战略将增加BPPV流程的使用。在该项目的具体目标1中,研究者将开发一个基于理论的、多方面的BPPV行为和教育策略(包括一个基于网络的多媒体护理点临床工具)。在具体目标2中,一项随机对照试验将使用先前验证的基于图像的研究方法来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,研究者将采用交错入组随机试验设计,在社区ED环境中实施和评估实施策略对BPPV流程使用的影响。探索性结果包括急诊科的效率和护理成本。为此项目组建了一支优秀的跨学科团队(神经科医生、耳鼻喉科医生、社区和学术急诊科医生、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。
项目成果
期刊论文数量(0)
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Kevin Anthony Kerber其他文献
Kevin Anthony Kerber的其他文献
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{{ truncateString('Kevin Anthony Kerber', 18)}}的其他基金
Self-Diagnosis and Treatment Tools for Benign Paroxysmal Positional Vertigo
良性阵发性位置性眩晕的自我诊断和治疗工具
- 批准号:
8665651 - 财政年份:2014
- 资助金额:
$ 61.11万 - 项目类别:
Self-Diagnosis and Treatment Tools for Benign Paroxysmal Positional Vertigo
良性阵发性位置性眩晕的自我诊断和治疗工具
- 批准号:
8828078 - 财政年份:2014
- 资助金额:
$ 61.11万 - 项目类别:
DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project
通过实施治疗头晕
- 批准号:
10559012 - 财政年份:2013
- 资助金额:
$ 61.11万 - 项目类别:
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
- 批准号:
8576151 - 财政年份:2013
- 资助金额:
$ 61.11万 - 项目类别:
DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project
通过实施治疗头晕
- 批准号:
10687853 - 财政年份:2013
- 资助金额:
$ 61.11万 - 项目类别:
DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project
通过实施治疗头晕
- 批准号:
10471884 - 财政年份:2013
- 资助金额:
$ 61.11万 - 项目类别:
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
- 批准号:
8885793 - 财政年份:2013
- 资助金额:
$ 61.11万 - 项目类别:
Solutions for Vertigo presentations in the Emergency Department (SOLVE) Project
急诊科眩晕演示解决方案 (SOLVE) 项目
- 批准号:
7938800 - 财政年份:2009
- 资助金额:
$ 61.11万 - 项目类别:
Solutions for Vertigo presentations in the Emergency Department (SOLVE) Project
急诊科眩晕演示解决方案 (SOLVE) 项目
- 批准号:
8098677 - 财政年份:2009
- 资助金额:
$ 61.11万 - 项目类别:
Solutions for Vertigo presentations in the Emergency Department (SOLVE) Project
急诊科眩晕演示解决方案 (SOLVE) 项目
- 批准号:
8271229 - 财政年份:2009
- 资助金额:
$ 61.11万 - 项目类别: