Dissemination and implementation of DIGEST™ as an evidence-based measurement tool for dysphagia in cancer

摘要 吞咽困难(吞咽困难)是一种非常普遍和有冲击力的情况，对 医疗保健系统。在一生中，吞咽困难与死亡风险过高、身长增加有关 住院、吸入性肺炎和营养不良，从而增加了医疗费用和资源利用率。不仅 吞咽困难是一种健康问题，也会对生活质量和日常功能造成不成比例的影响。 癌症幸存者。在临床实践中采用循证方法落后于发现数十年。 其中一个差距是语言病理学家采用循证实践(EBP)治疗吞咽困难 管理层。循证吞咽困难护理从循证吞咽评估开始。意义重大 在吞咽困难领域已取得进展，以开发基于证据的评估方法，特别是 强调吞咽的生理特征。吞咽的相对安全性和效率，即 食物或液体团块被保持在呼吸道之外并通过咽部完全清除到食道的程度， 是临床决策的根本驱动力-然而，在临床上仍然没有一致的评估和报告 练习一下。为了解决这一差距，研究人员开发了消化系统™(吞咽的动态成像等级 毒性)。Digest是一种EBP工具，用于根据咽部吞咽困难的结果对吞咽困难的严重程度进行分级 放射学(电视透视)改良吞钡(MBS)研究。Digest使用基本流程图和 题目(可通过PMC开放获取)，以总结渗透/吸入和咽部模式 MBS上观察到的残留物作为吞咽安全和有效的标志。《文摘》是一份务实而健壮的 在头颈部癌症人群中验证的措施，并在PI机构的常规实践中采用 自2016年开发以来，已有超过11,000 MB在临床上使用该方法进行分级。同行评审 研究表明，在外部学术医疗机构和联邦资助的临床试验中采用了Digest。 尽管有这样的承诺，但仍有几个障碍限制了在常规癌症护理中的广泛采用。这些措施包括 可伸缩性以适应PI环境之外的不同临床环境，以及最佳实施的不确定性 战略。这个项目的长期目标是改善吞咽困难的护理和患者的预后 将消化吸收纳入常规临床实践。我们的中心假设是，消化扩大维持 不同癌症人群在常见临床实践差异下的有效性，并促进可靠的采用 通过积极的实施战略。此应用程序的目标是使用传播和 实施(D&I)科学以实现以下具体目标：1)证明摘要的有效性 不同的肿瘤学人群和成像采集协议，2)检查自然环境和保真度 在现实世界、早期采用者中传播摘要，以及3)评估积极的实施战略，以 在临床实践中提高消化的可达性和保真度。凭借密集的多站点网络和内容专业知识， 调查人员拥有独特的装备来执行拟议中的D&I项目。我们希望这项工作能有所改进 通过缩小吞咽困难诊断方面的研究与实践之间的差距来进行护理。

ABSTRACT Dysphagia (difficulty swallowing) is a highly prevalent and impactful condition with significant burden on the healthcare system. Across the lifespan, dysphagia is associated with excess risk of mortality, increased length of stay, aspiration pneumonia, and malnutrition thereby elevating medical costs and resource utilization. Not only a health problem, dysphagia also adversely affects quality of life and daily function with disproportionate impact on cancer survivors. Adoption of evidence-based methods into clinical practice lags decades behind discovery. One such gap is adoption of evidence-based practices (EBP) by speech-language pathologists in dysphagia management. Evidence-based dysphagia care begins with evidence-based swallowing evaluation. Significant progress has been made in the field of dysphagia to develop evidence-based evaluation methods, with particular emphasis on physiologic characterization of swallowing. The relative safety and efficiency of swallowing, that is how well a food or liquid bolus is kept out of the airway and clears fully through the pharynx into the esophagus, is a fundamental driver of clinical decision making – yet, remains inconsistently assessed and reported in clinical practice. To address this gap, the investigators’ developed DIGEST™ (Dynamic Imaging Grade of Swallowing Toxicity). DIGEST is an EBP tool to grade the severity of pharyngeal dysphagia based on results of a radiographic (videofluoroscopic) modified barium swallow (MBS) study. DIGEST uses a basic flowsheet and rubric (available open access via PMC) to summarize the patterns of penetration/aspiration and pharyngeal residue observed on the MBS as markers of swallowing safety and efficiency. DIGEST is a pragmatic yet robust measure validated in the head and neck cancer population, and adopted into routine practice at the PI’s institution with over 11,000 MBS graded in the clinic using the methodology since development in 2016. Peer-reviewed research shows adoption of DIGEST in external academic medical settings and federally funded clinical trials. Despite this promise, several obstacles still limit widespread adoption in routine cancer care. These include scalability to fit diverse clinical contexts outside the PI’s environment and uncertainty about best implementation strategies. The long-term goal of this project is to improve dysphagia care and patient outcomes through reliable adoption of DIGEST into routine clinical practice. Our central hypothesis is that DIGEST scales-up maintaining validity in diverse cancer populations under common clinical practice variations with reliable adoption facilitated by an active implementation strategy. The objective of this application is to use dissemination and implementation (D&I) science to accomplish the following Specific Aims: 1) demonstrate validity of DIGEST in diverse oncology populations and imaging acquisition protocols, 2) examine context and fidelity of natural dissemination of DIGEST in real-world, early adopters, and 3) evaluate active implementation strategies to improve reach and fidelity of DIGEST in clinical practice. With dense multi-site networks and content expertise, the investigators are uniquely equipped to conduct the proposed D&I project. We expect this work to improve care by narrowing the research-to-practice gap in dysphagia diagnostics.