Using video games to increase implementation of clinical practice guidelines in trauma triage

使用视频游戏加强创伤分诊临床实践指南的实施

• 批准号: 10582783
• 负责人: Deepika Mohan
• 金额: $ 59.71万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-15 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582783
• 关键词: Academy; Accident and Emergency department; Address; Affect; Aging; Agreement; Behavior; Behavior assessment; Behavioral; Behavioral Sciences; Calibration; Caring; Clinical Practice Guideline; Clinical Sciences; Collaborations; Consolidated Framework for Implementation Research; Cues; Data; Decision Making; Detection; Development; Education; Effectiveness; Elderly; Emergency Department Physician; Emergency Medicine; Emergency department visit; Ensure; Evidence based intervention; Evidence based practice; Expenditure; Exposure to; Failure; Feedback; Goals; Guidelines; Health; Hospitalization; Hour; Incidence; Independent Living; Injury; Intervention; Interview; Intuition; Judgment; Laboratories; Link; Literature; Maintenance; Medical; Medicare claim; Medicine; Methods; Morbidity - disease rate; Pain; Paramedical Personnel; Participant; Patient-Focused Outcomes; Patients; Pattern Recognition; Persons; Physicians; Play; Power Sources; Qualitative Evaluations; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Refractory; Reporting; Research; Research Priority; Sampling; Scientist; Source; Structure; Testing; Text; Time; Training; Trauma; Trauma patient; Triage; Uncertainty; Variant; Video Games; Work; active control; behavior change; clinical implementation; cognitive process; compare effectiveness; comparison intervention; contextual factors; continuing medical education; cost; effectiveness/implementation study; effectiveness/implementation trial; experience; follow-up; future implementation; heuristics; hospital readmission; human old age (65+); implementation efforts; implementation science; improved; improved outcome; injury burden; insight; instrument; intervention effect; mortality; multidisciplinary; novel; outreach; pilot trial; pressure; preventable death; programs; provider behavior; recruit; severe injury; theories; therapy design; trauma centers; treatment as usual; trial design; videogame intervention; virtual reality simulation

PROJECT ABSTRACT Injury is the leading cause of loss of independence among those over the age 65, resulting in over 3 million Emergency Department (ED) visits, 800,000 hospitalizations, and greater than $50 billion in costs each year. Guideline-concordant triage of trauma patients – rapid identification of those with severe injuries and transfer to trauma centers – decreases mortality by 10 to 25%, reduces loss of independence, and diminishes pain at one year. Despite this evidence, however, under-triage persists (incidence: 50%), particularly among those over the age of 65 (incidence: 80%). To address this implementation gap, we propose to conduct a Type I hybrid effectiveness-implementation trial in which we test the effect of video game-based training on physician behavior. We designed this trial based on extensive preliminary studies, during which we isolated physician behavior as the single largest source of variation in triage practices, identified heuristics (pattern recognition) as a major cause of behavior, developed theory-based, customized video games to recalibrate physician heuristics (i.e., align them with clinical practice guidelines), and ensured their efficacy in the laboratory. For this trial, we will recruit a national sample of emergency medicine physicians (n=900), in collaboration with three large staffing organizations, and will randomize physicians to one of three interventions: video game-based training, text-based education (active control), or nothing (passive control). The specific aims of the trial are (1) to test the effect of the three interventions on behavioral (e.g., under-triage) and patient-centered outcomes (e.g., 30-day mortality) by linking trial data to Medicare claims, (2) to compare the mechanisms of action by which the active interventions affect physician behavior by using a suite of validated instruments, and (3) to identify contextual factors that influence implementation and maintenance of guidelines in practice by performing a comprehensive qualitative evaluation of trial participants (n=20) and a national sample of key decision makers (e.g., ED directors, patients [n=20/group]). Together these aims will provide critical insight into the effectiveness of our novel intervention and key data to inform future implementation efforts.

项目摘要 受伤是65岁以上老年人丧失独立性的主要原因，造成300多万人死亡 急诊科(ED)就诊、80万人次住院，以及每年超过500亿美元的费用。 指南-创伤患者的协调分诊-快速识别严重伤者并将其转移到 创伤中心-将死亡率降低10%至25%，减少丧失独立性，并在一次即可减轻疼痛 年。然而，尽管有这些证据，分流不足的情况仍然存在(发病率：50%)，特别是在那些超过 年龄65岁(发病率：80%)。为了解决这一实施差距，我们建议实施类型I混合 有效性-实施试验，我们测试基于视频游戏的培训对医生的影响 行为。我们基于广泛的初步研究设计了这项试验，在此期间我们隔离了一名医生 行为作为分类实践中最大的变异来源，确定了启发式(模式识别) 作为行为的主要原因，开发了基于理论的定制视频游戏来重新校准医生 试探法(即，使它们与临床实践指南保持一致)，并确保它们在实验室中的有效性。为了这个 在试验中，我们将招募全国急诊医生样本(n=900)，与三个 大型员工组织，并将随机选择医生进行以下三种干预之一：基于视频游戏 培训、基于文本的教育(主动控制)，或者什么都不做(被动控制)。试验的具体目的是(1) 测试三种干预措施对行为(例如，分诊不足)和以患者为中心的结果的影响 通过将试验数据与医疗保险索赔联系起来(例如，30天死亡率)，(2)通过以下方式比较行动机制 哪些积极的干预措施通过使用一套有效的工具影响医生的行为，以及(3) 通过以下方式确定在实践中影响准则实施和维持的背景因素 对试验参与者(n=20)进行全面的定性评估，并在全国范围内抽样调查 决策者(例如急诊科主任、患者[n=20/组])。这些目标加在一起将为我们提供对 我们新的干预措施的有效性和关键数据，为未来的执行工作提供信息。