Using video games to increase implementation of clinical practice guidelines in trauma triage

项目摘要 受伤是65岁以上的人失去独立的主要原因， 急诊科（艾德）就诊，80万次住院治疗，每年花费超过500亿美元。 创伤患者的指南-一致性分类-快速识别严重损伤并转移到 创伤中心-降低死亡率10%至25%，减少独立性的丧失， 年然而，尽管有这些证据，分类不足的情况仍然存在（发生率：50%），特别是在那些年龄超过10岁的人中。 65岁（发病率：80%）。为了解决这一实施差距，我们建议进行I型混合 有效性实施试验，我们在其中测试了基于视频游戏的培训对医生的影响， 行为我们根据广泛的初步研究设计了这项试验，在此期间，我们将医生 行为是检伤分类实践中最大的变异来源，确定了模式识别（模式识别） 作为行为的主要原因，开发了基于理论的定制视频游戏，以重新校准医生 物流学（即，使其与临床实践指南保持一致），并确保其在实验室中的有效性。为此 试验中，我们将招募一个全国性的急诊医学医生样本（n=900），与三个 大型人员配备组织，并将随机医生到三个干预措施之一：基于视频游戏 培训、基于文本的教育（主动控制）或无（被动控制）。审判的具体目的是（1） 为了测试三种干预对行为的影响（例如，分类不足）和以患者为中心的结局 (e.g., 30-日死亡率），通过将试验数据与医疗保险索赔联系起来，（2）比较作用机制， 主动干预通过使用一套经验证的仪器影响医生行为，以及（3） 通过以下方式确定影响实践中准则实施和维护的背景因素： 对试验参与者（n=20）进行全面的定性评价，并对关键的 决策者（例如，艾德主任，患者[n=20/组]）。这些目标将为以下方面提供重要的见解： 我们的新干预措施的有效性和为未来实施工作提供信息的关键数据。

PROJECT 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, however, under-triage persists (incidence: 50%), particularly among those over the age of 65 (incidence: 80%). To address this implementation gap, we propose to conduct a Type I hybrid effectiveness-implementation trial in which we test the effect of video game-based training on physician behavior. We designed this trial based on extensive preliminary studies, during which we isolated physician behavior as the single largest source of variation in triage practices, identified heuristics (pattern recognition) as a major cause of behavior, developed theory-based, customized video games to recalibrate physician heuristics (i.e., align them with clinical practice guidelines), and ensured their efficacy in the laboratory. For this trial, we will recruit a national sample of emergency medicine physicians (n=900), in collaboration with three large staffing organizations, and will randomize physicians to one of three interventions: video game-based training, text-based education (active control), or nothing (passive control). The specific aims of the trial are (1) to test the effect of the three interventions on behavioral (e.g., under-triage) and patient-centered outcomes (e.g., 30-day mortality) by linking trial data to Medicare claims, (2) to compare the mechanisms of action by which the active interventions affect physician behavior by using a suite of validated instruments, and (3) to identify contextual factors that influence implementation and maintenance of guidelines in practice by performing a comprehensive qualitative evaluation of trial participants (n=20) and a national sample of key decision makers (e.g., ED directors, patients [n=20/group]). Together these aims will provide critical insight into the effectiveness of our novel intervention and key data to inform future implementation efforts.