Development of a serious game to measure physician implementation of trauma triage guidelines

摘要 受伤是65岁以上老年人丧失独立性的主要原因，造成300多万人死亡 急诊科(ED)就诊、80万人次住院，以及每年超过500亿美元的费用。 指南-创伤患者的协调分诊-快速识别严重伤者并将其转移到 创伤中心-将死亡率降低10%至25%，减少丧失独立性，并在一次即可减轻疼痛 年。尽管有这些证据，但分类不足的情况仍然存在(发生率：50%)，特别是在#岁以上的人中。 65例(发病率：80%)。不遵守临床实践指南的原因因医生而异。 此外，让医生接触不适当的干预措施可能会产生严重的意想不到的后果。至 为了解决实现上的差距，我们建议开发一款新的严肃游戏(应用视频 游戏)，以衡量医生在创伤分诊中的行为，并确定不遵守规定的来源。在目标1中，我们 我将使用既定的、以用户为中心的设计过程来构建游戏，该过程涉及形成性研究和 利益相关者(n=20)、原型开发，然后通过与国家 方便抽样医师(n=30)。在目标2中，我们将建立 通过招募当地方便的医生样本(n=100)，审计他们的病历，并进行 半结构化访谈使我们可以评估内部一致性信度，重测信度、准则性 效度和收敛结构效度。该提案将提供一种工具，可用于向 在今后的努力中选择干预措施，以增加创伤分类指南的实施，以及 从而改善患者受伤后的转归。

ABSTRACT Injury is the leading cause of loss of independence among those over the age 65, resulting in over 3 million Emergency Department (ED) visits, 800,000 hospitalizations, and greater than $50 billion in costs each year. Guideline-concordant triage of trauma patients – rapid identification of those with severe injuries and transfer to trauma centers – decreases mortality by 10 to 25%, reduces loss of independence, and diminishes pain at one year. Despite this evidence, under-triage persists (incidence: 50%), particularly among those over the age of 65 (incidence: 80%). Causes of non-compliance with clinical practice guidelines varies among physicians. Moreover, exposing physicians to inappropriate interventions can have serious unintended consequences. To address the implementation gap, we therefore propose to develop a novel serious game (an applied video game) to measure physician behavior in trauma triage and to identify sources of non-compliance. In Aim 1, we will build the game using an established, user-centered design process that involves formative research with stakeholders (n=20), prototype development, and then calibration through iterative play-testing with a national convenience sample of physicians (n=30). In Aim 2, we will establish the initial measurement properties of the game by recruiting a local convenience sample of physicians (n=100), auditing their charts, and conducting semi-structured interviews so that we can assess internal consistency reliability, re-test reliability, criterion validity, and convergent construct validity. This proposal will deliver a tool that can be used to inform the selection of interventions in future efforts to increase the implementation of guidelines in trauma triage, and thereby to improve patient outcomes after injury.