Accelerating Adoption of Comparative Effectiveness Research in Premature Infants

描述(由申请人提供)：我们从现有的比较有效性研究中了解到，某些喂养做法和治疗方法会对早产儿造成全面伤害。我们已经证明，目前有大量早产儿接受了这些疗法。这项提案将改变处方和喂养做法，并测量25%在美国出生的极低出生体重(&lt；1500克出生体重)婴儿的这些做法的变化。这些变化将影响肠内营养(影响所有婴儿)和新生儿重症监护病房中12种最常见药物(抗生素、抗酸剂和类固醇)中6种药物的使用。我们将使用现有的电子医疗记录，其中包含每年12,000名早产儿的详细医疗信息。我们将分两个阶段实施比较有效性研究的结果。第一阶段将包括在质量首脑会议上对从业者进行教育，改变电子看护点界面，有针对性地提醒喂养和开处方做法以及与教育资源的链接。我们的团队将分析电子医疗记录中的喂养和处方数据，以及患者级别的人口统计数据，以确定每个目标表现最差的新生儿重症监护病房。然后，我们将对这些表现不佳的单位进行具体的教育干预。这项建议将：1)在278个新生儿重症监护病房实施现有的比较有效性研究制定的当前最佳做法；2)使用现有的电子病历测试这些做法的合规性；3)确定合规率不在最佳做法范围内的新生儿重症监护病房；4)使用有针对性的干预措施，进一步改善这些病房采用比较有效性研究的情况。该小组包括具有使用大型数据库进行比较有效性研究的经验的国际公认的专家。在过去的10年里，团队成员使用电子病历平台共同撰写了40篇同行评议的文章，这将是这项提案的核心。在一系列出版物、质量改进计划和教育计划中，我们：1)记录了喂养实践和与伤害相关的药物的广泛使用；2)开展了短期疗效比较项目；3)改变了全美新生儿专家的行为；4)开发了一个高功能的平台来实施拟议的项目。 公共卫生相关性：这项建议是学术研究人员、政府和私人执业新生儿专家之间的合作伙伴关系。我们将开发和测试干预措施，以有效地实施早产儿比较有效性研究的结果。获得有关喂养和处方做法的电子数据，再加上有针对性的教育干预，将增加早产儿接受母乳喂养的比例，并减少接触未经证实的药物的比例。

DESCRIPTION (provided by applicant): We know from existing comparative effectiveness research that certain feeding practices and therapeutics result in overall harm to preterm infants. We have shown that a large number of preterm infants are currently exposed to these therapies. This proposal will change prescribing and feeding practices and measure these practice changes in 25% of very low birth weight (<1500 g birth weight) infants born in the US. These changes will influence enteral nutrition (affecting all infants) and the use of 6 of the 12 most common medications (antibiotics, antacids, and steroids) administered in the neonatal intensive care unit. We will use an existing electronic medical record containing detailed healthcare information for 12,000 premature infants a year. We will implement the findings from comparative effectiveness research in 2 phases. The first phase will consist of practitioner education at a Quality Summit and changes to the electronic point-of-care interface with targeted reminders for feeding and prescribing practices and links to educational resources. Our team will analyze feeding and prescribing data from the electronic medical record, along with patient-level data on demographics to identify the worst-performing neonatal intensive care units for each of the AIMs. We will then use specific educational interventions for these poor-performing units. This proposal will: 1) implement current best practices developed from existing comparative effectiveness research across 278 neonatal intensive care units; 2) test compliance with these practices using an existing electronic medical record; 3) identify neonatal intensive care units with compliance rates that fall outside of best practices; and 4) use focused interventions to further improve adoption of comparative effectiveness research at these units. The team includes internationally recognized experts with experience conducting comparative effectiveness research using large databases. In the last 10 years, team members have co-authored 40 peer-reviewed articles using the electronic medical record platform that will be the centerpiece for this proposal. In a series of publications, quality improvement initiatives, and educational programs, we have: 1) documented the widespread use of feeding practices and medications associated with harm; 2) conducted short-term comparative effectiveness projects; 3) changed the behavior of neonatologists throughout the United States; and 4) developed a high-functioning platform to conduct the proposed project. PUBLIC HEALTH RELEVANCE: This proposal is a partnership between academic researchers, government, and private practice neonatologists. We will develop and test interventions to efficiently implement findings from comparative effectiveness research in preterm infants. Access to electronic data regarding feeding and prescribing practices coupled with targeted educational interventions will increase the proportion of preterm infants exposed to human milk feedings and decrease the proportion exposed to unproven medications.