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

项目总结和摘要 背景：食物过敏（FA）是一种潜在的危及生命的疾病， 在美国的孩子们。在食物过敏的儿童中，25%有花生过敏（PA），这是主要的过敏原之一。 致命的食物过敏反应的原因。2017年，NIAID发布了 美国花生过敏的预防[《花生过敏预防（PPA）指南》]， 建议在婴儿期饮食中引入花生产品。新的PPA指南提出了 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）测试或参考 高风险婴儿的过敏症;及（c）就如何及何时加入花生- 添加到婴儿的饮食中。虽然提供PPA指南一致的护理有可能 为了预防PA，研究表明，PPA指南的传播和实施已经 尽管提供者了解这些指导方针并对其持积极态度，但这些指导方针仍不充分。 具体目标和方法：这一以实践为基础的群组的主要和次要目标是： 随机对照试验旨在确定干预措施的有效性 减少儿童早期（花生）过敏（iREACH），以增加对PPA指南的遵守 实践中的儿科医生，随后降低花生过敏的发病率， 孩子iREACH，包含PPA指南教育模块，EHR集成CDS工具， 个月，并在EHR内跟进提示查询花生亲本介绍 实践儿科医生的依从性将在6个月访视后通过EHR数据提取进行测量。花生 过敏发生率将通过调查和EHR数据提取的家长报告相结合来测量。 其他探索性目标包括：1）通过EHR描述过敏专科医生对PPA指南的遵守情况 2）报告儿科医生遵守PPA指南的障碍/促进因素， 通过调查了解过敏症专家和家长，以及3）描述家长的依从率（花生产品 介绍和喂养频率）的PPA指南通过调查。 假设和预期结果：我们的初步研究假设是，与对照组婴儿相比， iREACH干预组中处于高风险和低/中度风险的婴儿， 遵循PPA准则。我们的次要假设是，与高和低/中度相比， 对照组中的风险婴儿，iREACH干预组中的花生过敏率较低。 对其他研究的意义和影响：这将是第一个系统地研究和 促进PPA准则的实施，这些准则有可能大大减少 美国PA的发病率及其相关发病率。如果被发现是有效的，iREACH是专为快速 通过各种共同的EHR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.