Intervention to Reduce Early (Peanut) Allergy in Children (iREACH)

项目摘要和摘要 背景：食物过敏(FA)是一种潜在威胁生命的疾病，估计影响8%的 美国的儿童。在对食物过敏的儿童中，25%的人对花生过敏(PA)，这是 致死食物的原因--过敏反应。2017年，NIAID发布了《关于 美国花生过敏预防[“花生过敏预防指南”]， 建议在婴儿期饮食中引入花生产品。新的PPA指导方针提出了 以下是儿科医生面临的直接临床挑战：(A)评估每个婴儿的PA风险，(B)测试或转介 向过敏专科医生咨询高危婴儿；以及(C)就如何以及何时添加花生- 在婴儿的饮食中含有产品。虽然提供符合PPA指南的护理具有潜在的 为了预防PA，研究表明，PPA准则的传播和实施 不充分，尽管提供商了解这些指南并对其持好感。 具体目标和方法：这一以实践为基础的分组的主要和次要目标是-- 随机对照试验是为了确定干预的有效性 通过增加对PPA指南的遵守来减少儿童早期(花生)过敏(IReach) 儿科医生的实践，并随后降低花生过敏的发生率 孩子们。IReach整合了PPA指南教育模块，这是一个集成了EHR的CDS工具，在4-和6- 月，以及EHR内询问亲本花生引种的后续提示 练习。在为期6个月的访问后，将通过EHR数据提取来衡量儿科医生的依从性。花生 过敏发生率将通过调查家长报告和EHR数据提取相结合的方式进行测量。 其他探索性目标包括：1)描述过敏专科医生通过电子病历遵守PPA指南 提取，2)报告儿科医生遵守PPA指南的障碍/促进者， 过敏专科医生和父母通过调查，以及3)描述父母的忠诚率(花生产品 介绍和喂养频率)通过调查获得PPA指南。 假设和预期结果：我们的主要研究假设是，与对照组的婴儿相比 在iReach干预ARM中，高危和低危/中危的ARM婴儿将有更高的儿科医生就诊率 遵守PPA指导方针。我们的第二个假设是，当与高和低/中相比时 在控制组中，风险婴儿在iReach干预组中的婴儿将有较低的花生过敏率。 对其他研究的意义和影响：这将是第一次系统地考察和 促进执行《公私伙伴关系准则》，该准则有可能大幅减少 PA的发病率及其在美国的相关发病率。如果被发现是有效的，iReach是为快速 通过各种共同的电子健康记录平台在全国范围内传播和实施。

PROJECT SUMMARY AND ABSTRACT Background: Food allergy (FA) is a potentially life-threatening condition that affects an estimated 8% of children in the United States. Among food-allergic children, 25% have a peanut allergy (PA), one of the leading causes of fatal food-allergic reactions. In 2017, the NIAID published the Addendum Guidelines for the Prevention of Peanut Allergy in the United States [“Prevention of Peanut Allergy (PPA) Guidelines”], recommending dietary introduction of peanut products during infancy. The new PPA Guidelines present the following immediate clinical challenges for pediatricians: (a) to assess each infant's PA risk, (b) to test or refer high-risk infants to allergists; and (c) to counsel parents regarding how and when to incorporate peanut- containing products into an infant's diet. While the provision of PPA Guideline-consistent care has the potential to prevent PA, research has shown that dissemination and implementation of the PPA Guidelines has been inadequate, even though providers are knowledgeable about the guidelines and view them favorably. Specific Aims and Methods: The primary and secondary aims of this practice-based cluster- randomized controlled trial are to determine the effectiveness of an Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) in increasing adherence to PPA Guideline practices among pediatricians and subsequently decreasing the incidence of peanut allergy in children. iREACH, incorporates a PPA Guideline education module, an EHR-integrated CDS tool at 4- and 6- months, and follow-up prompts within the EHR inquiring about parental peanut introduction practices. Pediatrician adherence will be measured through EHR data extraction after the 6-month visit. Peanut allergy incidence will be measured through a combination of parent-report via survey and EHR data extraction. Other exploratory objectives include: 1) Describing allergist adherence to the PPA Guidelines via EHR extraction, 2) Reporting barriers/facilitators for PPA Guideline adherence among pediatricians, allergists and parents via surveys, and 3) Describing rates of parental adherence (peanut product introduction and feeding frequency) to the PPA Guidelines via survey. Hypotheses and Expected Results: Our primary study hypothesis is that compared with infants in the control arm infants at high and low/moderate risk in the iREACH intervention arm, will have higher rates of pediatrician adherence to the PPA Guidelines. Our secondary hypothesis is that when compared to high and low/moderate risk infants in the control arm, those in the iREACH intervention arm will have lower rates of peanut allergy. Significance and Effects on Other Research: This will be the first study to systematically examine and promote the implementation of the PPA Guidelines, which have the potential to dramatically reduce the incidence of PA and its associated morbidity in the US. If found to be effective, iREACH is designed for swift national dissemination and implementation via a variety of common EHR platforms.