Research and Development of an Online Enteral Nutrition Practitioner Tutorial

描述(申请人提供)：肠内营养(EN)通过饲管为那些不能以口服方式满足其营养需求但仍能保持足够的消化和吸收功能的个人提供营养。研究已经确定了当适当使用EN时，许多医疗、营养和成本方面的好处。然而，肠内喂养的患者在获得肠道接触时或在肠内营养期间容易发生不良事件(例如，感染、代谢、胃肠道和营养并发症)，这可能导致发病率和死亡率的增加。不幸的是，许多医疗从业者缺乏最新的培训，无法以最安全和最有效的方式提供EN，部分原因是掌握基于证据的知识和专业技能可能具有挑战性和耗时；而且全面的、跨学科的EN培训计划并不广泛。开发肠内营养实践者教程--一个基于案例的在线学习计划--是为了克服这些挑战而提出的一项战略。 第一阶段非常成功，取得了以下成果：1)开发了拟议的课程；2)确定了软件功能，以最大限度地提高教学效果；3)制定了第二阶段的内容开发计划；4)创建了原型内容交付平台，并提供了示范内容样本；5)在第二阶段进行了两项严格的研究设计。 对于这个第二阶段的SBIR项目，医学教育技术研发公司MD Informatics(MDI)将与美国肠外和肠内营养协会(A.S.P.E.N，一家专业营养支持协会)合作开发肠内营养从业者教程(ENPT)课程。然后，MDI将与InterMountain Healthcare合作，验证ENPT的教学方法在长期知识保留和临床医生实践行为改善方面的有效性。ENPT第二阶段的完成和评估将为跨学科医疗从业者提供急需的EN培训资源，并实现以下目标：1)促进安全实践，以最大限度地提高潜在效益，减少可预防的EN相关并发症；2)提供研究机会，以确定最有效地影响EN实践行为的教育方法。这项建议与NIH的使命是一致的，通过应用医学和行为研究来减轻国家的疾病负担。此外，这项建议提供了一种创新的方法，通过促进在机构和家庭护理环境中需要EN的越来越多的患者获得安全、有效、以患者为中心、及时、高效和公平的护理，帮助实现医学研究所(IOM)质量鸿沟报告提出的关键医疗目标。公共卫生相关性：医学教育的一个基本目标是确保医疗从业者及时将最佳实践研究纳入常规患者护理。将开发的产品是肠内营养从业者教程(ENPT)，将提供创新的计算机辅助教学(CAI)，以促进医疗从业者将基于证据的EN研究转化为实践行为和系统范围的协议和指南的能力。MD Informatics(MDI)认为：1)拟议的ENPT对公众健康的影响将是最大限度地发挥潜在的好处，同时减少与EN交付相关的可预防的不良事件的发生率，2)在第二阶段进行的研究将证明，使用该教程将对长期知识保留和临床医生执业行为产生有利影响。

DESCRIPTION (provided by applicant): Enteral nutrition (EN) provides nutrients through a feeding tube for individuals who cannot meet their nutrition needs orally yet retain adequate digestive and absorptive function. Research has identified numerous medical, nutrition, and cost benefits when EN is used appropriately. However, enterally-fed patients are vulnerable to adverse events when obtaining enteral access or during the delivery of EN (e.g. infectious, metabolic, gastrointestinal, and nutrition complications), which can result in increased morbidity and mortality. Unfortunately, many healthcare practitioners lack up-to-date training to deliver EN in the safest and most effective manner, in part because mastery of evidence-based knowledge and specialized skills can be challenging and time consuming; and a comprehensive, interdisciplinary EN training program is not widely available. The development of the Enteral Nutrition Practitioner Tutorial - An Online Case-Based Learning Program is proposed as a strategy to overcome these challenges. Phase I was highly successful and resulted in: 1) the development of the proposed course curriculum; 2) identification of software features to maximize pedagogical effectiveness, 3) a content development plan for Phase II; 4) creation of the prototype content delivery platforms, with sample content for demonstration; and 5) two rigorous research designs to be conducted in Phase II. For this Phase II SBIR project, MD Informatics (MDI), a medical education technology R&D company, will collaborate with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N., a professional nutrition support society) to develop the Enteral Nutrition Practitioner Tutorial (ENPT) courseware. MDI will then collaborate with Intermountain Healthcare to validate ENPT's pedagogical approach for effectiveness in long-term knowledge retention and improvement in clinician practice behavior. Completion and evaluation of ENPT in Phase II will provide a much-needed EN training resource for interdisciplinary healthcare practitioners and fulfill the goals of: 1) promoting safe practices to maximize the potential benefits and reduce preventable EN-related complications, and 2) providing a research opportunity to identify educational methods that most effectively influence EN practice behaviors. This proposal is consistent with the mission of NIH by applying medical and behavioral research to reduce the nation's burden of illness. Furthermore, this proposal offers an innovative approach to help fulfill the key healthcare aims set forth by the Institute of Medicine's (IOM) Quality Chasm reports by promoting safe, effective, patient-centered, timely, efficient, and equitable care to the increasing number of patients who require EN in institutional and home care settings. PUBLIC HEALTH RELEVANCE: A fundamental objective of medical education is to assure that healthcare practitioners incorporate best practice research into routine patient care in a timely manner. The product to be developed, an Enteral Nutrition Practitioner Tutorial (ENPT), will offer innovative computer-assisted instruction (CAI) to facilitate healthcare practitioners' ability to translate evidence-based EN research into practice behaviors and system-wide protocols and guidelines. MD Informatics (MDI) believes that: 1) the public health implications of the proposed ENPT will be to maximize the potential benefits, while reducing the incidence of preventable adverse events associated with the delivery of EN, and 2) research conducted in Phase II will demonstrate that use of the tutorial leads to favorable effects on long-term knowledge retention and clinician practice behavior.