Measuring overuse of continuous pulse oximetry in bronchiolitis and developing strategies for large-scale deimplementation: study protocol for a feasibility trial

Pilot and Feasibility Studies

Irit R. Rasooly¹  Christopher P. Bonafide²  Lisa M. McLeod³  Patrick W. Brady⁴  Amanda Schondelmeyer⁴  Christopher P. Landrigan⁵  Frances Barg⁶  Rinad S. Beidas⁷  Courtney Benjamin Wolk⁸ 

[1] 0000 0001 0680 8770, grid.239552.a, Section of Hospital Medicine, Children’s Hospital of Philadelphia, Buerger Center for Advanced Pediatric Care, 3500 Civic Center Blvd., 11th Floor, Philadelphia, PA, USA;0000 0001 0680 8770, grid.239552.a, Section of Hospital Medicine, Children’s Hospital of Philadelphia, Buerger Center for Advanced Pediatric Care, 3500 Civic Center Blvd., 11th Floor, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Leonard Davis Institute of Health Economics, University of Pennsylvania, 3535 Market Street, Suite 3006, Philadelphia, PA, USA;0000 0001 0680 8770, grid.239552.a, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, USA;0000 0001 0690 7621, grid.413957.d, Department of Pediatrics, Section of Hospital Medicine, Children’s Hospital Colorado, 13123 E. 16th Street, Aurora, CO, USA;0000 0001 0703 675X, grid.430503.1, Adult Child Consortium for Outcomes Research and Healthcare Delivery Sciences, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO, USA;0000 0001 2179 9593, grid.24827.3b, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 9016, Cincinnati, OH, USA;0000 0000 9025 8099, grid.239573.9, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 9016, Cincinnati, OH, USA;0000 0000 9025 8099, grid.239573.9, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 7014, Cincinnati, OH, USA;0000 0004 0378 8438, grid.2515.3, Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Enders 1, Boston, MA, USA;0000 0004 0378 8294, grid.62560.37, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA;000000041936754X, grid.38142.3c, Harvard Medical School, 25 Shattuck St., Boston, MA, USA;0000 0004 1936 8972, grid.25879.31, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3015, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Leonard Davis Institute of Health Economics, University of Pennsylvania, 3535 Market Street, Suite 3006, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 3015, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Leonard Davis Institute of Health Economics, University of Pennsylvania, 3535 Market Street, Suite 3006, Philadelphia, PA, USA;

关键词: Bronchiolitis;    Overuse;    Deimplementation;    Implementation science;    Pediatric hospital medicine;   

DOI  :  10.1186/s40814-019-0453-2

来源: publisher

【 摘 要 】

BackgroundDeimplementation, the systematic elimination of low-value practices, has emerged as an important focus within implementation science. Bronchiolitis is the leading cause of infant hospitalization. Among stable inpatients with bronchiolitis who do not require supplemental oxygen, continuous pulse oximetry monitoring is recognized as an overused, low-value practice in pediatric hospital medicine. There is strong scientific evidence and practice guideline support for limiting pulse oximetry monitoring of stable children with bronchiolitis who do not require supplemental oxygen, yet the practice remains common. This study aims to (1) characterize the extent of this overuse in hospitals located in the USA and Canada, (2) identify barriers and facilitators of successful deimplementation of continuous pulse oximetry monitoring in bronchiolitis, and (3) develop consensus strategies for large-scale deimplementation. In addition to identifying feasible strategies for deimplementation, this study will test the feasibility of data collection approaches to be employed in a large-scale deimplementation trial.MethodsThis multicenter study will be performed in approximately 38 hospitals in the Pediatric Research in Inpatient Settings Network. In Aim 1, we will determine the rate of overuse within each hospital by performing repeated cross-sectional observational sampling of continuous pulse oximetry monitoring of stable bronchiolitis patients age 8 weeks through 23 months who do not require supplemental oxygen. In Aim 2, we will use the Consolidated Framework for Implementation Research (CFIR) as a framework for semi-structured interviews with key stakeholders (physician, nurse, respiratory therapist, administrator, and parent) at the highest- and lowest-overuse hospitals to understand barriers and facilitators of continuous pulse oximetry monitoring deimplementation. In Aim 3, we will use a theory-based causal model to match the identified barriers and facilitators to potential strategies for deimplementation. Candidate strategies will be discussed with a panel of stakeholders from hospitals with high rates of overuse to assess feasibility and acceptability. A questionnaire ranking strategies based on feasibility, acceptability, and impact will be administered to a broader group of stakeholders to arrive at consensus about promising strategies for large-scale deimplementation to be tested in a subsequent trial.DiscussionEffective strategies for deimplementing continuous pulse oximetry monitoring of stable patients with bronchiolitis have not been well characterized. The findings of this study will provide further understanding of factors that facilitate deimplementation in pediatric hospital settings and provide pilot and feasibility data to inform a trial of large-scale deimplementation of this overused practice.Trial registrationNot applicable. This study does not meet the World Health Organization definition of a clinical trial.

【 授权许可】

CC BY