Preparing for a hybrid trial of pulse oximetry de-implementation in stable infants with bronchiolitis

项目总结/摘要 在理解如何最好地取消可能存在的医疗保健实践方面存在根本性的差距 以前是有道理的，但由于新的证据，不再有利。急性细支气管炎是一种 呼吸道病毒感染引起的婴幼儿常见肺部疾病。连续脉搏血氧监测 尽管有临床实践，但稳定的毛细支气管炎住院婴儿是一种过度使用的做法 指导方针和越来越多的证据阻止其使用。过度使用连续脉搏血氧饱和度监测可 延长住院时间（这也会增加遭受医源性伤害的风险），增加成本，并导致 警报疲劳申请人的长期目标是更好地了解最有效的策略 取消可能伤害住院儿童的低价值护理做法。整体 本申请的目的是获得对脉搏血氧饱和度过度使用的全面理解，并开发一种 稳定型毛细支气管炎患者连续脉搏血氧监测的多方面实施策略 不需要补充氧气的患者。在这个项目中，我们将准备消除监视器过度使用 (EMO)脉搏血氧测定试验，一项基于统一框架的有效性实施试验， 实施研究的重点是取消过度使用连续脉搏血氧饱和度监测， 细支气管炎。提出这项研究的理由是，有证据表明，脉搏血氧饱和度过度使用发生 在几乎一半的毛细支气管炎婴儿中，没有监测指征， 过度使用的医院间差异。在本建议中，我们将追求三个具体目标：（1）措施 基线脉搏血氧饱和度监测不需要补充的毛细支气管炎婴儿的过度使用率 氧气在儿科研究住院设置网络医院，（2）确定障碍和促进者，以去- 通过与关键利益相关者进行半结构化访谈， 过度使用率最高和最低的医院，以及（3）制定一个多方面的脉冲去实现战略 在不需要补充氧气的毛细支气管炎婴儿中过度使用血氧监测， 将在混合试验中测试干预措施。申请人认为，这种方法是创新的，因为它 重点是儿科去执行，它是在执行科学框架和行为基础上， 理论，它采用严格的方法来制定去实现战略合作， 医生、护士、呼吸治疗师、管理人员和家长利益相关者。拟议的研究是 重要的是，它与每年因细支气管炎入院的100，000名婴儿和儿童有关。在 此外，该项目还将通过全面了解 在儿科人群中取消实施的障碍和促进因素，并直接导致混合试验， 测试严格制定的取消执行战略。

PROJECT SUMMARY/ABSTRACT There is a fundamental gap in understanding how best to de-implement health care practices that may have previously made sense, but because of new evidence, are no longer favorable. Acute bronchiolitis is a common lung disease of infants caused by respiratory viral infection. Continuous pulse oximetry monitoring in stable hospitalized infants with bronchiolitis is an overused practice that has persisted despite clinical practice guidelines and mounting evidence discouraging its use. Overuse of continuous pulse oximetry monitoring can prolong length of stay (which also elevates risk of suffering iatrogenic harm), increase costs, and contribute to alarm fatigue. The long term goal of the applicant is to better understand the strategies that are most effective for de-implementing low value care practices that have the potential to harm hospitalized children. The overall objective of this application is to gain a comprehensive understanding of pulse oximetry overuse and develop a multifaceted de-implementation strategy for continuous pulse oximetry monitoring in stable bronchiolitis patients not requiring supplemental oxygen. In this project, we will prepare for the Eliminating Monitor Overuse (EMO) Pulse Oximetry Trial, an effectiveness-implementation trial grounded in the Consolidated Framework for Implementation Research focused on de-implementing overuse of continuous pulse oximetry monitoring in bronchiolitis. The rationale for the proposed research is that evidence suggests pulse oximetry overuse occurs in nearly half of all infants with bronchiolitis for whom there is no monitoring indication, and there is high between-hospital variability in overuse. In this proposal we will pursue three Specific Aims: (1) Measure baseline pulse oximetry monitoring overuse rates in infants with bronchiolitis not requiring supplemental oxygen in Pediatric Research in Inpatient Settings Network hospitals, (2) Identify barriers and facilitators to de- implementing pulse oximetry monitoring by conducting semi-structured interviews with key stakeholders at the highest- and lowest-overuse hospitals, and (3) Develop a multifaceted de-implementation strategy for pulse oximetry monitoring overuse in infants with bronchiolitis not requiring supplemental oxygen that will serve as the intervention to be tested in a hybrid trial. This approach is innovative, in the applicant’s opinion, because it focuses on pediatric de-implementation, it is grounded in implementation science frameworks and behavioral theory, and it applies rigorous methods to developing de-implementation strategies in collaboration with physician, nurse, respiratory therapist, administrator, and parent stakeholders. The proposed research is significant because it is relevant to the 100,000 infants and children admitted with bronchiolitis each year. In addition, this project will advance implementation science by building a comprehensive understanding of barriers and facilitators to de-implementation in a pediatric population and leading directly to a hybrid trial to test a rigorously developed de-implementation strategy.