A Rapid-Throughput Feedback Intervention for Population-Scale Communication Quali

针对人口规模通信质量的快速吞吐量反馈干预

• 批准号: 7829511
• 负责人: Michael Henry Farrell
• 金额: $ 49.99万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7829511
• 关键词: Address; Adoption; Age; American; Area; Back; Behavior; Bioethics; Bioethics Consultants; Birth; Blood; Businesses; Characteristics; Child; Child health care; Clinical Services; Communication; Communities; Counseling; Cystic Fibrosis; Data; Data Collection; Disease; Emerging Technologies; Employee; Ethical Issues; Factor Analysis; Feedback; Female; Future; Genetic Carriers; Genetic Screening; Genetic Transcription; Geographic Locations; Goals; Hand; Health Communication; Health Personnel; Healthcare; Hemoglobinopathies; Human Genome Project; Individual; Infant; Inservice Training; Intervention; Knowledge; Lead; Left; Lung; Measures; Methods; Minority Groups; Molecular Genetics; Neonatal Screening; Newborn Infant; Occupations; Outcome; Parents; Participant; Patients; Performance; Phase; Phase III Clinical Trials; Physicians; Population; Population Intervention; Positioning Attribute; Procedures; Process; Protocols documentation; Public Health; Publishing; Quality Indicator; Randomized Controlled Trials; Recovery; Relative (related person); Reporting; Research; Resources; Running; Safety; Sample Size; Sampling; Schedule; Scientific Advances and Accomplishments; Screening Result; Screening procedure; Series; Services; Sickle Cell; Solutions; Staging; Techniques; Technology; Test Result; Testing; Time; TimeLine; Training; Underrepresented Minority; United States National Institutes of Health; Wisconsin; abstracting; behavior change; communication behavior; design; experience; follow-up; improved; medical specialties; outer surface lipoprotein; policy implication; post intervention; programs; psychosocial; rehearsal; software development; therapy design; time interval

DESCRIPTION (provided by applicant): and abstract This application addresses broad Challenge Area (02) Bioethics, and specific Challenge Topic 02-OD(OSP)-101, "Unique ethical issues posed by emerging technologies." BACKGROUND. Genetic and molecular testing technologies have expanded rapidly into the newborn screening programs that are used for nearly every U.S. newborn. These techniques lead to biomedical benefit for some infants but troubling psychosocial harms for far more infants who have false positive or genetic carrier results. A mechanism is needed to insure that screening lead to more good than harm, in order to insure the long-term survival of newborn screening for the lung condition cystic fibrosis (CF) and the blood condition sickle cell hemoglobinopathy (SCH). Since many psychosocial problems are the result of parent misunderstandings about the results' significance, we are responding to the challenge by developing a mechanism to assess and improve the processes and outcomes of clinicians' communication with parents. We have previously developed a communication assessment method that is feasible for use on a population scale, using rehearsals and a quality indicator approach to operationalize individual behaviors like the number and relative timing of jargon words, assessments of understanding, and specific content messages. In the current study we will develop and evaluate a rapid-throughput technique to provide feedback and support to clinicians about their communication quality indicator scores. AIMS. (1) To pilot-test and finalize design of a rapid-throughput feedback and support intervention designed to improve processes of communication after newborn screening for CF and SCH. (2) To determine whether rapid provision of feedback via a "report card" will improve clinicians' communication quality indicator scores. The proposal also responds to the economy-stimulating goals of the American Recovery and Reinvestment Act by hiring 6 new employees and engaging with two U.S. small businesses to do our research transcription and software development. METHODS. We have adapted our communication assessment method to be done on a rapid-throughput timeline that should have immediate utility for participating clinicians. The project includes 3 tightly-timed phases. In phase 1 (months 1-2) we will finalize informational content of the report card and accompanying support materials, and hire and train the new employees to accomplish the rapid-throughput procedure. In phase 2 (months 3-6) we will pilot test the procedure with a series of resident physicians. Phase 3 (months 7-22) will be a randomized controlled trial of the report card and materials over a sample of 400 child health providers identified via a random search of the AMA Masterfile. Participant scores on a panel of communication quality indicators will be measured at baseline and follow-up after sending a random sample the report card feedback and support materials. SIGNIFICANCE. Improving communication is said to be an important solution to bioethical problems, and there is ample data about problems with clinicians' communication. Most previously published efforts to assess and improve communication require more resources than would be feasible for routine widespread use. An effective mechanism to improve communication quality will help to answer bioethicist challenges about the safety of genetic screening, and insure that newborn screening for CF and SCH lead to more good than harm. In the long run, we believe that a population-scale method to improve communication will benefit health providers in other specialties and the experiences and outcomes of their patients. The U.S. public health community screens nearly every U.S. newborn for inborn diseases, but misunderstanding about the meaning of test results can lead to serious psychosocial problems, the raising of public concerns, and delays in implementing new screening tests. This proposal responds to the challenge of insuring that more good than harm comes from use of new screening technologies, so that newborn screening may expand its services to new communities. The project will implement and evaluate a population-scale method designed to improve clinicians' communication about newborn screening results.

描述(由申请人提供)： 本申请涉及广泛的挑战领域(02)生物伦理，以及具体的挑战主题02-OD(OSP)-101，“新兴技术提出的独特伦理问题”。 背景资料。基因和分子检测技术已经迅速扩展到几乎每个美国新生儿都使用的新生儿筛查计划中。这些技术为一些婴儿带来了生物医学上的好处，但对更多有假阳性或基因携带者结果的婴儿来说，却带来了令人不安的心理社会伤害。需要一种机制来确保筛查利大于弊，以确保肺部囊性纤维化(CF)和血液条件镰状细胞血红蛋白病(SCH)筛查的新生儿长期生存。由于许多心理社会问题是父母对结果意义的误解造成的，我们正在开发一种机制来评估和改善临床医生与父母沟通的过程和结果，以应对这一挑战。我们之前已经开发了一种可行的沟通评估方法，可以在人口规模上使用，使用排练和质量指标方法来操作个别行为，如行话单词的数量和相对时间、理解评估和特定内容消息。在当前的研究中，我们将开发和评估一种快速吞吐量技术，以向临床医生提供关于他们的沟通质量指标评分的反馈和支持。 目标。(1)试行并最终确定快速通过反馈和支持干预的设计，旨在改善新生儿筛查CF和SCH后的沟通过程。(2)确定通过“成绩单”快速提供反馈是否会提高临床医生的沟通质量指标得分。该提案还响应了《美国复苏和再投资法案》的刺激经济目标，雇用了6名新员工，并与两家美国小企业合作，进行我们的研究、转录和软件开发。 方法：研究方法。我们已经调整了我们的沟通评估方法，以在快速吞吐量的时间线上进行，这应该对参与的临床医生立即有用。该项目包括3个紧凑的时间阶段。在第一阶段(1-2个月)，我们将最终确定成绩单和随附的支持材料的信息内容，并雇用和培训新员工以完成快速处理程序。在第二阶段(3-6个月)，我们将在一系列住院医生中试行该程序。第三阶段(7-22个月)将是一项随机对照试验，通过随机搜索AMA主文件确定400名儿童保健提供者的成绩单和材料。参与者在一组沟通质量指标上的分数将在基线时测量，并在随机发送样本、成绩单反馈和支持材料后进行后续测量。意义重大。改善沟通被认为是生物伦理问题的重要解决方案，关于临床医生沟通问题的数据非常充足。大多数以前发表的评估和改善通信的努力所需的资源超过了常规广泛使用的可行资源。一个有效的提高沟通质量的机制将有助于回答生物伦理学家对基因筛查安全性的挑战，并确保对新生儿进行CF和SCH筛查利大于弊。从长远来看，我们相信，一种改善沟通的人口规模方法将使其他专科的卫生服务提供者及其患者的经验和结果受益。美国公共卫生界对几乎每个美国新生儿进行先天疾病筛查，但对测试结果意义的误解可能会导致严重的心理社会问题，引发公众担忧，并推迟实施新的筛查测试。这项提议是为了应对这样的挑战，即确保使用新的筛查技术利大于弊，以便新生儿筛查可以将其服务扩展到新的社区。该项目将实施和评估一种人口规模的方法，旨在改善临床医生对新生儿筛查结果的沟通。