Developing a Shared Decision-Making Support Tool to Promote Evidence-based Treatment for Veterans with Post-concussive Sleep Conditions

开发共享决策支持工具，以促进对患有脑震荡后睡眠状况的退伍军人进行循证治疗

• 批准号: 10641926
• 负责人: Adam Kinney
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641926
• 关键词: Access to Information; Address; Brain; Brain Concussion; Caring; Clinical; Clinical Practice Guideline; Cognition; Collaborations; Computerized Medical Record; Data; Decision Aid; Decision Support Systems; Development; Effectiveness; Ensure; Evidence based treatment; Feedback; Fostering; Grant; Guidelines; Healthcare; Intervention; Interview; Investments; Manuals; Methodology; Methods; Military Personnel; Mission; Nature; Obstructive Sleep Apnea; Patient-Centered Care; Patients; Policy Maker; Post-Concussion Syndrome; Practice Management; Productivity; Provider; Quality of Care; Quality of life; Recommendation; Recovery; Recovery of Function; Rehabilitation Centers; Rehabilitation therapy; Research; Risk; Selection for Treatments; Services; Sleep; Sleep Deprivation; Sleep Disorders; Sleep disturbances; Sleeplessness; Specific qualifier value; Structure; Symptoms; System; Training; Veterans; Visual; Work; acceptability and feasibility; compliance behavior; dashboard; design; disability; effectiveness evaluation; evidence base; evidence based guidelines; experience; high risk; implementation strategy; mild traumatic brain injury; mortality; patient response; point of care; preference; prototype; rehabilitative care; routine care; screening; shared decision making; sleep quality; support tools; targeted treatment; tool; treatment center; treatment response; treatment strategy

Background: Veterans with mild traumatic brain injury (mTBI) are at high risk for sleep conditions (insomnia; obstructive sleep apnea [OSA]), which disrupt sleep quality and undermine recovery. Identifying and treating such sleep conditions using the VA/DoD clinical practice guideline (CPG) for the management of insomnia and OSA (Sleep CPG) can produce wide-ranging benefits for Veterans’ post-concussive recovery. Significance: The Sleep CPG specifies an evidence-based workflow for management of sleep conditions, including: 1) screening for sleep problems; 2) assessing for sleep conditions; and, 3) delivering evidence- based treatments. Further, the Sleep CPG includes a recommendation that Veterans and providers collaborate to select empirically supported treatments to ensure that care aligns with Veterans’ preferences (i.e., Veteran- centered care). However, there exists variability in Veterans’ receipt of guideline-concordant care (GCC) for post-concussive sleep conditions due in part to: 1) lack of access to guideline-recommended practices at the point-of-care (PoC); and, 2) challenges associated with facilitating Veteran-centered care due to the highly individualized nature of Veterans’ preferences. Implementation strategies can enable GCC and facilitate Veterans’ recovery by providing: 1) Veterans and providers with information regarding guideline-recommended practices at the PoC; and, 2) structured support to facilitate Veteran-centered care. However, such strategies have yet to be widely developed or implemented. The proposed project will address this gap in rehabilitative care for those with mTBI and sleep conditions by developing a decision support system. The system will be comprised of two complementary tools. First, it will include a clinical dashboard that distills patient-level data into actionable information at the PoC, providing decision support with respect to: 1) screening for sleep problems; 2) assessments to detect insomnia and/or OSA; and, 3) recommending guideline-concordant treatment options based on clinical presentation. Second, a decision aid will facilitate collaboration between providers and Veterans to promote selection of guideline-concordant treatment recommendations that align with patients’ personal preferences. This will be accomplished by providing Veterans with necessary information and assisting them with clarifying their priorities for intervention. The proposed system will be the first to offer decision support across the continuum of GCC, from screening for sleep problems to Veteran- centered treatment of identified conditions. Specific Aims and Methodology: In Aim 1, we will use semi-structured interviews with Veterans, providers, and policymakers to identify barriers and facilitators to evidence-based, Veteran-centered management of post-concussive sleep conditions. In Aim 2, we will leverage stakeholder input from Aim 1 to develop a decision support system (i.e., dashboard, decision aid) and training materials. We will also use manual chart review to validate the accuracy with which the clinical dashboard provides actionable information to Veterans and providers at the point-of-care. In Aim 3, we will evaluate stakeholder feedback to assess the feasibility and acceptability of the decision support system and associated training materials. After presenting components to stakeholders (e.g., Veterans); we will use a mixed-methods design to elicit feedback and use that feedback to refine the prototype and materials until feasibility and acceptability criteria are met. Deliverables from this proposed project include a feasible, acceptable, and validated support tool capable of ensuring that Veterans with post-concussive sleep conditions receive evidence-based, Veteran- centered care. Findings will enable a subsequent application for a VA RR&D Merit IIR that examines the effectiveness of the decision support system on Veterans’ receipt of quality care and their functional recovery.

背景：轻度创伤性脑损伤（MTBI）的退伍军人处于睡眠状况的高风险（失眠； 阻塞性睡眠呼吸暂停[OSA]），这破坏了睡眠质量并破坏恢复。识别和治疗 使用VA/DOD临床实践指南（CPG）的这种睡眠条件，用于管理失眠和 OSA（睡眠CPG）可以为退伍军人的脑后恢复带来广泛的福利。 意义：睡眠CPG指定了用于管理睡眠条件的循证工作流程， 包括：1）筛查睡眠问题； 2）评估睡眠条件； 3）提供证据 - 基于治疗。此外，睡眠CPG包括退伍军人和提供者合作的建议 选择经验支持的治疗，以确保护理与退伍军人的偏好保持一致（即资深人士 - 中心护理）。但是，退伍军人收到指导方案护理（GCC）的可变性 障碍后的睡眠条件部分是由以下部分归因于：1）缺乏访问指南的习惯 护理点（POC）；以及2）由于高度高度的支持，与支持资深护理相关的挑战 退伍军人偏好的个性化本质。实施策略可以实现海湾合作委员会并促进 退伍军人通过提供：1）退伍军人和提供者提供有关指导申请的信息 POC的实践； 2）结构化支持以促进以资深的护理为中心。但是，这种策略 尚未广泛开发或实施。拟议的项目将在康复方面解决这一差距 通过开发决策支持系统来照顾患有MTBI和睡眠条件的人。系统将是 完成了两个完成工具。首先，它将包括一个临床仪表板，该仪表板提炼患者级数据 在POC中进入可操作的信息，提供有关以下方面的决策支持：1）筛选睡眠 问题； 2）评估检测失眠和/或OSA的评估； 3）建议指导条件 基于临床表现的治疗选择。第二，决策援助将有助于合作 提供者和退伍军人，以促进选择准则的治疗建议的选择 具有患者的个人喜好。这将通过为退伍军人提供必要的 信息并协助他们确定干预的优先级。拟议的系统将是 首先要在整个海湾合作委员会的连续体中提供决策支持，从筛查睡眠问题到资深人士 以确定条件为中心的治疗。 具体目的和方法论：在AIM 1中，我们将使用与退伍军人，提供者的半结构化访谈， 和决策者确定障碍和促进者，以循证，以资深人士为中心的管理 脑后睡眠状况。在AIM 2中，我们将利用AIM 1的利益相关者的意见来开发一个 决策支持系统（即仪表板，决策援助）和培训材料。我们还将使用手动图表 审查以验证临床仪表板向退伍军人提供可行信息的准确性 和服务点的提供者。在AIM 3中，我们将评估利益相关者的反馈，以评估可行性和 决策支持系统和相关培训材料的可接受性。将组件提交给 利益相关者（例如退伍军人）；我们将使用混合方法设计来引起反馈，并将这些反馈使用 完善原型和材料，直到满足可行性和可接受性标准为止。 该拟议项目的可交付成果包括可行，可接受且经过验证的支持工具 能够确保患有障碍后睡眠条件的退伍军人接受基于证据的资深人士 - 中心护理。调查结果将启用随后的VA RR＆D值得IIR的申请 决策支持系统对退伍军人获得优质护理及其功能的有效性 恢复。