The ROUTT-B (Reduce Over-Utilized Tests and Treatments in Bronchiolitis) Study: Developing a Roadmap for De-Implementation

项目摘要 该提案的总体目标是将细支气管炎作为一个案例研究，以推进疾病的科学研究。 通过确定减少过度检测和过度治疗的战略和程序， 细支气管炎，后来可以广泛适应不同的情况和疾病过程。新阶段所面临的挑战 毛细支气管炎的一个重要原因是，提供高质量的循证护理需要“少即是多”的方法，因为非 大多数住院患者接受的推荐的、过时的和潜在有害的检查和治疗确实 没有替代品。因此，细支气管炎是最常见的住院原因， 婴儿，是一个理想的条件，研究去执行。 在她的一系列项目中，泰勒博士提出了传播的创新应用， 实施（D&I）科学的独特问题去实施。在学习健康系统中 泰勒博士将使用PRISM D&I模型作为指导：1）使用定性方法定义 从医疗保健提供者的角度来看，影响细支气管炎过度使用的背景因素， 父母和医疗机构，2）制定一套务实，可行，有效的去执行 毛细支气管炎的策略，包括如何使策略适应当地情况的指导，以及3） 进行试点研究，以确定取消的可行性、可接受性和取消的有效性， 执行战略。作为第一次探索的语境因素助长过度使用或使 成功地取消执行，这项研究预计将产生宝贵的知识， 在疾病和医疗保健环境中实施。研究结果将为大规模、 务实的，随机对照试验的执行策略，使无效的，潜在的 减少有害的医疗做法。 申请人，艾米泰勒，医学博士，MSCS是非常准备完成拟议的研究，鉴于 她过去的训练和经验。为了在这一经验的基础上， 目标，泰勒博士寻求利用这个职业发展奖，以实现调查的独立性， 促进对有效和可推广的方法的科学了解， 有害的测试和治疗。这项工作将促进儿科指南的一致性，高质量，急性护理 患者，AHRQ优先人群。泰勒博士组建了一个国际公认的导师团队 与她的传播和实施科学（D&I）的培训目标直接相关的专业知识（博士。 Dempsey和格拉斯哥），定性研究（Dempsey和Holtrop博士），和务实的临床试验（Drs。 Dempsey和格拉斯哥）。她将在合作环境中进行拟议的研究， 由成人和儿童健康联盟支持的科罗拉多大学安舒茨医学院 成果研究和交付科学D&I科学和成果研究核心。

PROJECT SUMMARY The overarching goal of this proposal is to use bronchiolitis as a case study to advance the science of de- implementation by identifying strategies and processes for reducing over-testing and over-treatment in bronchiolitis that can later be broadly adapted to varied contexts and disease processes. The challenge in bronchiolitis is that providing high-quality, evidenced-based care requires a “less is more” approach as the non- recommended, outdated, and potentially harmful tests and treatments that most admitted patients receive do not have replacements. Therefore, bronchiolitis which is the most common cause of hospitalization among infants, is an ideal condition to study de-implementation. In her set of projects, Dr. Tyler proposes the innovative application of dissemination and implementation (D&I) science to the unique problem of de-implementation. Within a learning health system called PEDSnet, Dr. Tyler will use the PRISM D&I model as a guide to: 1) use qualitative methods to define contextual factors influencing over-utilization in bronchiolitis from the perspective of healthcare providers, parents, and healthcare organizations, 2) develop a set of pragmatic, feasible, and effective de-implementation strategies for bronchiolitis that includes guidance on how to adapt the strategies to local contexts, and 3) conduct a pilot study to determine the feasibility, acceptability, and de-implementation effectiveness of the de- implementation strategies. As one of the first explorations of contextual factors fostering overuse or enabling successful de-implementation, this study is expected to generate valuable knowledge relevant to de- implementation across diseases and healthcare settings. The results will provide pilot data for a large-scale, pragmatic, randomized-controlled trial of the de-implementation strategies so that ineffective and potentially harmful medical practices are reduced. The applicant, Amy Tyler, MD, MSCS is excellently prepared to complete the proposed research, given her past training and experience. To build upon this experience and progress toward her long-term career goals, Dr. Tyler seeks to use this career development award to achieve investigative independence and advance scientific understanding of effective and generalizable methods for de-implementing potentially harmful tests and treatments. This work will promote guideline concordant, high quality, acute care for pediatric patients, an AHRQ priority population. Dr. Tyler has assembled an internationally-recognized mentorship team with expertise directly related to her training goals in dissemination and implementation science (D&I) (Drs. Dempsey and Glasgow), qualitative research (Drs. Dempsey and Holtrop), and pragmatic clinical trials (Drs. Dempsey and Glasgow). She will conduct the proposed research in the collaborative environment of the University of Colorado Anschutz Medical Campus supported by the Adult and Child Consortium for Health Outcomes Research and Delivery Science D&I Science and Outcomes Research Cores.