Eliminating Monitor Overuse (EMO) Hybrid Effectiveness-Deimplementation Trial

项目总结/摘要 取消过度使用的卫生干预措施是最大限度地提高质量和减少浪费的重要步骤 在美国的医疗保健系统中。急性毛细支气管炎是小儿常见的肺部疾病 由呼吸道病毒感染引起。连续脉搏血氧饱和度监测在住院婴儿中的应用 未接受补充氧气的毛细支气管炎患者是一种过度使用的干预措施， 证明它在这一人群中无效，并可能造成伤害。三项国家指导方针现在不鼓励 未接受治疗的毛细支气管炎住院婴儿的连续脉搏血氧监测 补充氧气在初步研究中，研究人员表明，连续脉搏血氧饱和度过度使用， 发生在所有无监测指征的毛细支气管炎住院婴儿中的近一半， 在过度使用方面，医院之间的差异很大。申请人的首要目标是确定 哪些战略对于取消过度使用的卫生干预措施最有效，这些措施有可能 伤害孩子。此应用程序的总体目标是执行消除监视器过度使用（EMO） SpO 2试验，一项采用纵向分组随机设计的混合III型有效性-去实现试验 在32个儿科研究住院设置网络医院。审判将考验一个忘却 取消执行战略（教育推广与审计和反馈）与联合取消学习+ 替代取消实施战略（增加电子健康记录集成临床路径） 毛细支气管炎患儿连续脉搏血氧饱和度监测的可持续性 没有接受辅助供氧本建议包括三个具体目标：（1）比较 单纯遗忘策略与遗忘+替代策略对去执行结果的影响，（2） 使用混合方法确定与渗透和可持续性有关的取消执行战略机制， 以及（3）检查取消对临床结果和意外后果的影响。这 这种方法是创新的，因为它侧重于研究不足的儿科去实现领域， 实验设计反映了国家的最先进的理论框架的去执行干预措施，和 主要成果的重点是取消执行的长期可持续性，这与 公众这项拟议中的研究意义重大，因为它将推动医疗保健提供科学的发展， 每年有10万儿童住院的高发病率儿科肺病，急性病毒性细支气管炎。的 试验还将提供新的见解的过程，机制，成本和结果的大，严格- 设计的反执行工作。

PROJECT SUMMARY/ABSTRACT Deimplementing overused health interventions is an essential step in maximizing quality and minimizing waste in the United States health care system. Acute bronchiolitis is a common lung disease of young children caused by respiratory viral infection. Continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen is an overused intervention that has persisted despite evidence that it is ineffective in this population and may cause harm. Three national guidelines now discourage continuous pulse oximetry monitoring in hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. In preliminary studies, the investigators showed that continuous pulse oximetry overuse occurs in nearly half of all hospitalized infants with bronchiolitis for whom there is no monitoring indication, and there is high between-hospital variability in overuse. The overarching goal of the applicants is to determine which strategies are most effective for deimplementing overused health interventions that have the potential to harm children. The overall objective of this application is to conduct the Eliminating Monitor Overuse (EMO) SpO2 trial, a hybrid type III effectiveness-deimplementation trial with a longitudinal cluster-randomized design in 32 Pediatric Research in Inpatient Settings Network hospitals. The trial will test an unlearning deimplementation strategy (educational outreach with audit & feedback) vs. a combined unlearning + substitution deimplementation strategy (adding an electronic health record-integrated clinical pathway) on sustainability of continuous pulse oximetry monitoring deimplementation in children with bronchiolitis who are not receiving supplemental oxygen. This proposal includes three Specific Aims: (1) Compare the effects of the unlearning only strategy versus the unlearning + substitution strategy on deimplementation outcomes, (2) Identify deimplementation strategy mechanisms linked to penetration and sustainability using mixed methods, and (3) Examine the effects of deimplementation on clinical outcomes and unintended consequences. This approach is innovative because it focuses on the under-researched area of pediatric deimplementation, the experimental design reflects state-of-the-art theoretical framing of deimplementation interventions, and the primary outcome focuses on long-term sustainability of deimplementation, which is highly relevant to the public. The proposed research is significant because it will advance the science of health care delivery for a high incidence pediatric lung disease that hospitalizes 100,000 children annually, acute viral bronchiolitis. The trial will also provide new insights into the processes, mechanisms, costs, and outcomes of large, rigorously- designed deimplementation efforts.