Eliminating Monitor Overuse (EMO) Hybrid Effectiveness-Deimplementation Trial

项目摘要/摘要 杜绝过度使用的卫生干预措施是最大限度提高质量和最大限度减少浪费的关键一步 在美国的医疗保健系统中。摘要急性毛细支气管炎是儿童常见的肺部疾病。 由呼吸道病毒感染引起。连续脉搏血氧饱和度监测在住院婴幼儿中的应用 没有补充氧气的毛细支气管炎是一种过度使用的干预措施，尽管 有证据表明它在这一人群中无效，并可能造成伤害。三个国家的指导方针现在不鼓励 未接受治疗的毛细支气管炎住院婴儿连续脉搏血氧饱和度监测 补充氧气。在初步研究中，研究人员表明，连续脉搏血氧仪过度使用 在所有没有监测指征的毛细支气管炎住院婴儿中，有近一半发生这种情况，以及 过度使用存在很高的医院间变异性。申请者的首要目标是确定 哪些战略最有效地杜绝了过度使用的卫生干预措施 伤害儿童。此应用程序的总体目标是进行消除监视器过度使用(EMO) SpO2试验，一项采用纵向分组随机设计的混合型III型有效性-去实施试验 在32个儿科住院患者设置的网络医院。这场审判将考验一种忘却 取消实施战略(通过审计和反馈进行教育推广)与综合遗忘+ 替代取消实施策略(增加电子健康记录-综合临床路径) 持续脉搏血氧饱和度监测毛细支气管炎患儿停药的可持续性 没有补充氧气。这项建议包括三个具体目标：(1)比较 仅遗忘策略与遗忘+替代策略在去实施效果上的比较(2) 使用混合方法确定与渗透率和可持续性相联系的非执行战略机制， 以及(3)检查取消实施对临床结果和意外后果的影响。这 方法是创新的，因为它侧重于儿科取消实施这一研究不足的领域， 实验设计反映了取消执行干预措施的最新理论框架， 主要成果侧重于解除执行的长期可持续性，这与 公开的。这项拟议的研究具有重要意义，因为它将推动医疗保健提供的科学 每年有10万名儿童住院的高发儿童肺部疾病，急性病毒性毛细支气管炎。这个 试验还将提供对大型、严格- 设计了取消执行的努力。

PROJECT SUMMARY/ABSTRACT Deimplementing overused health interventions is an essential step in maximizing quality and minimizing waste in the United States health care system. Acute bronchiolitis is a common lung disease of young children caused by respiratory viral infection. Continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen is an overused intervention that has persisted despite evidence that it is ineffective in this population and may cause harm. Three national guidelines now discourage continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. In preliminary studies, the investigators showed that continuous pulse oximetry overuse occurs in nearly half of all hospitalized infants with bronchiolitis for whom there is no monitoring indication, and there is high between-hospital variability in overuse. The overarching goal of the applicants is to determine which strategies are most effective for deimplementing overused health interventions that have the potential to harm children. The overall objective of this application is to conduct the Eliminating Monitor Overuse (EMO) SpO2 trial, a hybrid type III effectiveness-deimplementation trial with a longitudinal cluster-randomized design in 32 Pediatric Research in Inpatient Settings Network hospitals. The trial will test an unlearning deimplementation strategy (educational outreach with audit & feedback) vs. a combined unlearning + substitution deimplementation strategy (adding an electronic health record-integrated clinical pathway) on sustainability of continuous pulse oximetry monitoring deimplementation in children with bronchiolitis who are not receiving supplemental oxygen. This proposal includes three Specific Aims: (1) Compare the effects of the unlearning only strategy versus the unlearning + substitution strategy on deimplementation outcomes, (2) Identify deimplementation strategy mechanisms linked to penetration and sustainability using mixed methods, and (3) Examine the effects of deimplementation on clinical outcomes and unintended consequences. This approach is innovative because it focuses on the under-researched area of pediatric deimplementation, the experimental design reflects state-of-the-art theoretical framing of deimplementation interventions, and the primary outcome focuses on long-term sustainability of deimplementation, which is highly relevant to the public. The proposed research is significant because it will advance the science of health care delivery for a high incidence pediatric lung disease that hospitalizes 100,000 children annually, acute viral bronchiolitis. The trial will also provide new insights into the processes, mechanisms, costs, and outcomes of large, rigorously- designed deimplementation efforts.