Time-pressured decision making in trauma triage

描述（由申请人提供）：我的研究项目的总体目标是改善创伤患者的护理。创伤对年轻人和健康人的影响尤为严重，每年直接医疗费用和生产力损失超过4000亿美元。区域化，将中度至重度损伤患者转移到高水平的学术创伤中心，改善了结果。美国外科医师学会创伤委员会（ACS-COT）试图通过针对已知的行为决定因素（知识、态度和组织约束）来改进区域化。然而，医生对ACS-COT创伤患者分诊指南的依从性仍低于60%。当前的行为科学文献表明，存在其他重要的决策决定因素，包括直觉判断（启发式）。启发式对创伤分诊决策的影响尚不清楚。利用基本行为和社会科学研究的见解和方法，对创伤分诊中的医生决策进行分析，可能会发现不坚持治疗的其他决定因素。通过解释ACS-COT努力改变医生行为和当前实践模式之间存在的差异，该项目具有改变当前创伤质量改进范例的潜力。为了实现这项研究计划的目标，并使自己成为与创伤相关的卫生服务研究的主要研究人员，我需要在以下方面进行进一步的培训：1)医生决策基础的理论结构；2)在医生决策过程中进行严谨、复杂的研究所必需的方法论工具，3)过渡到独立研究者所必需的管理和领导技能。在导师的指导下，我制定了以下几页所描述的教学和研究计划。他们将共同提供必要的知识和技能，以开展尖端的多学科研究，将行为科学的见解转化为应用策略，以修改医生对国家创伤分诊指南的遵守。拟进行的研究包括三个相互关联的研究。目标1将改进在初步工作中开发的工具，以研究医生在实验条件下的分诊决定。目的2将区分错误的启发式和知识缺陷对医生分诊决策的影响。目标3将开发一种新的干预措施，针对启发式或知识缺陷，以帮助医生做出更好的分诊决定。这些实验为未来在r01资助的多中心观察性试验中测试干预措施的有效性奠定了基础。我相信，对我职业发展的投资将有助于对创伤中的医生决策有新的理解，可能会改善对创伤患者的护理，并有可能催化我们改善卫生保健质量的方法的变化。

DESCRIPTION (provided by applicant): The overarching goal of my program of research is to improve the care of trauma patients. Trauma disproportionately affects the young and healthy, consuming over $US400 billion annually in direct medical costs and lost productivity. Regionalization, the transfer of moderately to severely injured patients to high level, academic trauma centers, improves outcomes. The American College of Surgeons - Committee on Trauma (ACS-COT) has attempted to improve regionalization by targeting known determinants of behavior: knowledge, attitudes, and organizational constraints. However, physician adherence to the ACS-COT's guidelines for the triage of trauma patients remains less than 60%. Current behavioral science literature suggests that other important determinants of decision making exist, including intuitive judgments (heuristics). The influence of heuristics on trauma triage decision making is unknown. An analysis of physician decision making in trauma triage that uses the insights and methodology of basic behavioral and social sciences research may allow the identification of additional determinants of non-adherence. By providing an explanation for the discrepancy that exists between the ACS-COT's efforts to change physician behavior and current practice patterns, this project holds the potential to alter the current paradigm of quality improvement in trauma. To achieve the goals of this research plan and to establish myself as a leading researcher in health services research related to trauma, I require further training in the following areas: 1) the theoretical constructs underlying physician decisio making; 2) the methodological tools necessary to conduct rigorous, sophisticated research in physician decision making, and 3) the management and leadership skills necessary to transition into an independent investigator. Under the guidance of my mentors, I have devised the didactic and research plan described in the following pages. Together, they will provide the necessary knowledge and skills to conduct cutting-edge, multi-disciplinary research that translates insights from behavioral science into an applied strategy to modify physician adherence to national trauma triage guidelines. The proposed research involves three inter-related studies. Aim 1 will refine a tool, developed in preliminary work, to study physician triage decisions under experimental conditions. Aim 2 will differentiate between the influence of faulty heuristics and knowledge deficits on physician triage decisions. Aim 3 will develop a novel intervention that targets either heuristics or knowledge deficits to help physicians make better triage decisions. These experiments set the stage for future work to test the effectiveness of the intervention in an R01-funded multi-center observational trial. I believe this investment in my career development will contribute to a new understanding of physician decision making in trauma, may improve the care provided to trauma patients, and has the potential to catalyze a change in our approach to quality improvement in health care.