De-implementation of Low-Value Testing in Patients Undergoing Low-Risk Surgery

项目摘要/摘要 不必要的检查和治疗是可预防的患者伤害的两个最大来源 美国医疗保健支出过剩。强有力的证据表明常规的术前检查 如心电图、血液和尿液检查，以及低风险手术前的胸部X光检查 预防不良事件或改善结果。此外，不必要的术前检查可能会引发护理 级联导致额外的专科会诊和侵入性程序，可能导致 严重的患者伤害、手术延误和患者经济毒性。无数的专业协会 建议不要在低风险手术前进行常规的术前检查，但取消使用已被证明 很难。在美国，很少有调查人员超越描述低价值检测或 测试针对单一手术(如白内障手术)或医院的有限策略。因此，有 没有可广泛扩展的取消实施战略和不必要、浪费和有害的测试 司空见惯。这项研究将测试一种理论知识丰富、可广泛扩展的多层次、多组件去中心化 实施战略，以减少不必要的术前低风险手术前检查 程序和实践类型。在密歇根价值协作(MVC)中，一个由87个密歇根州组成的财团 在医院，超过52%的患者在低风险手术前进行常规的术前检查。 设施差异从8%到85%不等。我们的初步数据已经确定了重要的，但可以修改的 不必要测试的决定因素。基于这些发现，我们将测试一种多层次、多组件的去噪 在密歇根医院实施战略。使用联合设施参加密歇根外科手术 质量协作(MSQC)，美国最大的外科手术协作质量改进计划 在美国，我们将通过阶梯式楔形群随机试验评估我们干预措施的有效性。

PROJECT SUMMARY/ABSTRACT Unnecessary tests and treatments represent two of the greatest sources of preventable patient harm and excess healthcare spending in the United States. Robust evidence demonstrates routine preoperative tests such as electrocardiograms, blood and urine tests, and chest radiographs before low-risk surgery do not prevent adverse events or improve outcomes. In addition, unnecessary preoperative testing can trigger care cascades leading to additional specialty consultations and invasive procedures, potentially resulting in significant patient harm, delays in surgery, and patient financial toxicity. Numerous professional societies recommend against routine preoperative testing prior to low-risk surgery but eliminating use has proven difficult. In the US, few investigators have moved beyond describing the prevalence of low value testing or testing limited strategies targeting a single procedure (i.e., cataract surgery) or hospital. As a result, there are no broadly scalable de-implementation strategies and unnecessary, wasteful, and harmful testing remains commonplace. This research will test a theory-informed and broadly scalable multi-level, multi-component de- implementation strategy to reduce unnecessary preoperative testing before low-risk surgery across diverse procedures and practice types. In the Michigan Value Collaborative (MVC), a consortium of 87 Michigan hospitals, routine preoperative testing occurs before low-risk surgery in more than 52% of patients with inter- facility variation ranging from 8% to 85%. Our preliminary data has identified important, yet modifiable determinants of unnecessary testing. Based on these findings, we will test a multi-level, multi-component de- implementation strategy across Michigan hospitals. Using facilities jointly participating in the Michigan Surgical Quality Collaborative (MSQC), the largest surgical collaborative quality improvement program in the United States, we will evaluate the effectiveness of our intervention through a stepped wedge cluster randomized trial.