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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：
8885793
负责人：
Kevin Anthony Kerber
金额：
$ 61.82万
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 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8885793
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 Communities Data Decision Aid Development Diagnosis Disease Distress Dizziness Effectiveness Emergency Department Physician Emergency Department patient Emergency Medicine Enrollment Evaluation Evidence based practice Exposure to Future Goals Guidelines Head Head and Neck Surgery Head and neck structure Health Health Services Research Healthcare Hour 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 neuroimaging particle point of care population based post intervention randomized trial routine care routine practice secondary outcome stem theories tool trial comparing trial design

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现实世界医学中的应用之间存在巨大差距。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，会导致失能症状。这种疾病源于进入内耳半规管（“管石”）的自由漂浮颗粒。 BPPV 通过简单而可靠的位置测试，即 Dix-Hallpike 测试 (DHT) 进行诊断。 Canalith 重新定位疗法 (CRM) 治疗只需几分钟即可在床边完成。随机接受 CRM 的 BPPV 患者 24 小时治愈率为 80%，而随机接受假手术的患者治愈率仅为 10%。然而，这些指南支持的流程（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）尚未充分传播到日常实践中。这些流程的未充分利用已在多种不同的环境中得到证实。急诊科 (ED) 的一项基于人群的研究的初步结果发现，在头晕症状中，有 3.9% 的人接受了 DHT（3,525 人中的 137 人），而 0.2% 的人（3,525 人中的 8 人）接受了 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 ED 患者，这一发现进一步凸显了效率低下。急诊科提供者将眩晕主题列为成人患者决策支持开发的第一要务。研究人员提供的额外初步数据表明，急诊医生对 BPPV 的管理支持有很高的需求。该项目的目标是在 ED 中实施 BPPV 流程。中心假设是多方面策略将增加 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点临床工具）。在具体目标 2 中，将使用先前经过验证的基于小插图的研究方法，使用随机对照试验来测试决策辅助对指南一致实践模式和 BPPV 知识的影响。在具体目标 3 中，研究人员将在社区 ED 环境中采用交错入组随机试验设计来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室效率和护理成本。对于这个项目，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师、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，该团队拥有跨多个领域的广泛内容专业知识以及成功的行为干预项目的历史。