Prevalence and correlates of pediatric guideline deviation across 9 health facilities

9 个卫生机构儿科指南偏差的患病率和相关性

• 批准号: 9805678
• 负责人: Arianna Rubin Means
• 金额: $ 7.78万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-17 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9805678
• 关键词: 2 year old; Acute; Address; Adherence; Admission activity; Africa; Age; Antibiotics; Asia; Bangladesh; Behavior; Burkina Faso; Caring; Cessation of life; Child; Child Health; Child Mortality; Childhood; Clinical; Clinical Management; Clinical Treatment; Clinical Trials Database; Comorbidity; Complex; Country; Data; Data Analyses; Data Collection; Data Set; Diagnosis; Diagnostic; Diarrhea; Disease; Documentation; Dysentery; Ensure; Evidence based intervention; Exhibits; Feedback; Focus Groups; Frequencies; Goals; Guideline Adherence; Guidelines; Health; Health Personnel; Health care facility; Hospitalized Child; Household; Inpatients; Intake; Intervention; Kenya; Knowledge; Malawi; Malnutrition; Maps; Modeling; Oral; Outcome; Pakistan; Patient Self-Report; Patients; Pneumonia; Prevalence; Provider; Quality of Care; Recommendation; Rehydrations; Research; Resources; Risk; Risk Factors; Salts; Series; Severity of illness; Site; Surveys; Sustainable Development; Syndrome; Target Populations; Training; Triage; Uganda; World Health Organization; Zinc; attributable mortality; clinical decision-making; cohort; contextual factors; design; effective intervention; evidence base; hospital organization; implementation science; implementation strategy; improved; innovation; interdisciplinary approach; lens; low and middle-income countries; mortality; nutrition; prevent; preventable death; treatment guidelines; uptake

ABSTRACT An estimated 15,000 children under the age of five die every day. Primary causes of mortality include pneumonia and diarrhea, and nearly half of deaths are attributable to undernutrition. These syndromes all have available interventions to reduce mortality, however in many settings acutely ill children are not provided necessary evidence-based care. It is estimated that over half of child deaths are preventable with simple, existing, appropriately applied evidence-based interventions. Pediatric clinical treatment guidelines synthesize evidence to ensure that all children are treated with high quality care. Yet, fidelity to guidelines is variable and guideline knowledge exceeds adherence to recommendations. The objective of this study is to describe and evaluate the complex factors influencing pediatric guideline deviation in low-and-middle-income countries where most preventable pediatric deaths occur. This evidence is crucial for developing appropriate implementation strategies that can effectively improve pediatric quality of care in low-resource settings. This study involves both secondary data analysis and primary data collection and is nested within the Childhood Acute Illness and Nutrition (CHAIN) project, which has established a global research network to investigate risk factors for death in acutely ill children. This study will utilize existing CHAIN cohort data from nine health facilities in six countries to evaluate the frequency with which health providers deviate from established pediatric treatment guidelines, and factors that influence deviation. We will extract diagnostic and treatment criteria from each of the six country national guidelines, specifically for pneumonia, diarrhea, and severe acute malnutrition (SAM) sub-syndromes. We will map these criteria across CHAIN cohort data to identify the frequency with which providers deviate from the national guidelines on which they have been trained. We will additionally analyze CHAIN intake data to identify patient-level, provider-level, and contextual factors influencing provider deviation from guidelines. This will generate valuable information regarding multi-level factors that influence clinical decision making. Findings regarding the prevalence of guideline deviation across CHAIN will be used to identify the CHAIN site with the lowest observed guideline adherence across targeted syndromes. Primary qualitative data collection will take place in this site wherein health providers and supervisors will participate in focus group discussions (FGDs). Qualitative data collection and analysis will be guided by the Theoretical Domains Framework, an implementation science framework that can be applied to identify determinants of behavior. The combination of secondary data analysis and primary data collection will allow for triangulation between self-reported influences and observed influences of guideline deviation. This study is an innovative approach to rapidly understand the complex factors influencing quality of care for vulnerable children, providing an opportunity to develop optimized implementation strategies to improve guideline adherence and reduce preventable child mortality.

抽象的 估计每天有15,000名五岁以下的儿童死亡。死亡率的主要原因包括肺炎 腹泻和近一半的死亡归因于营养不足。这些综合征都可用 降低死亡率的干预措施，但是在许多情况下，没有必要 循证护理。据估计，超过一半的儿童死亡是可以通过简单的，现有的， 适当应用基于证据的干预措施。小儿临床治疗指南合成证据 确保所有儿童都受到高质量护理的治疗。然而，对准则的保真度是可变的，指南 知识超越了建议。这项研究的目的是描述和评估 影响大多数中低收入国家的小儿指南偏差的复杂因素 可预防的小儿死亡发生。该证据对于制定适当的实施策略至关重要 这可以有效地改善低资源环境中的小儿护理质量。这项研究涉及二级 数据分析和主要数据收集，并嵌套在儿童急性疾病和营养（链）中 项目已经建立了一个全球研究网络，以调查急性病儿童死亡的危险因素。 这项研究将利用来自六个国家的九个医疗机构的现有链队列数据来评估 卫生提供者偏离已建立的儿科治疗指南的频率以及这些因素 影响偏差。我们将从六个国家国家中的每个国家提取诊断和治疗标准 指南，专门针对肺炎，腹泻和严重的急性营养不良（SAM）亚合并。我们将 跨链群数据绘制这些标准，以确定提供者偏离的频率 他们接受过培训的国家准则。我们将进一步分析链进气数据以识别 患者级别，提供者级别以及影响提供者偏离准则的背景因素。这会 生成有关影响临床决策的多层次因素的宝贵信息。 有关跨链条指南偏差的患病率的发现将用于识别链位 在靶向综合征之间，观察到的指南依从性最低。主要定性数据收集 将在此网站举行，卫生提供者和主管将参加焦点小组讨论 （FGD）。定性数据收集和分析将以理论领域框架为指导 实施科学框架可以应用于确定行为的决定因素。结合 二级数据分析和主要数据收集将允许自我报告影响之间的三角剖分 并观察到指南偏差的影响。这项研究是一种迅速了解的创新方法 影响弱势儿童护理质量的复杂因素，提供了开发优化的机会 实施策略，以提高准则依从性并降低可预防的儿童死亡率。