- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04302207
The ROUTT-B (Reduce Over-Utilized Tests and Treatments in Bronchiolitis) Study (ROUTT-B)
The ROUTT-B (Reduce Over-Utilized Tests and Treatments in Bronchiolitis) Study: Developing a Roadmap for De-Implementation
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The overarching goal of this proposal is to use bronchiolitis as a case study to advance the science of de-implementation by identifying strategies and processes for reducing over-testing and over-treatment in bronchiolitis that can later be broadly adapted to varied contexts and disease processes. The challenge in bronchiolitis is that providing high-quality, evidenced-based care requires a "less is more" approach as the non- recommended, outdated, and potentially harmful tests and treatments that most admitted patients receive do not have replacements. Therefore, bronchiolitis which is the most common cause of hospitalization among infants, is an ideal condition to study de-implementation.
In her set of projects, Dr. Tyler proposes the innovative application of dissemination and implementation (D&I) science to the unique problem of de-implementation. Within a learning health system called PEDSnet, Dr. Tyler will use the PRISM D&I model as a guide to: 1) use qualitative methods to define contextual factors influencing over-utilization in bronchiolitis from the perspective of healthcare providers, parents, and healthcare organizations, 2) develop a set of pragmatic, feasible, and effective de-implementation strategies for bronchiolitis that includes guidance on how to adapt the strategies to local contexts, and 3) conduct a pilot study to determine the feasibility, acceptability, and de-implementation effectiveness of the de-implementation strategies. As one of the first explorations of contextual factors fostering overuse or enabling successful de-implementation, this study is expected to generate valuable knowledge relevant to de- implementation across diseases and healthcare settings. The results will provide pilot data for a large-scale, pragmatic, randomized-controlled trial of the de-implementation strategies so that ineffective and potentially harmful medical practices are reduced.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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Colorado
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Aurora, Colorado, United States, 80045
- Children's Hospital Colorado
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Ohio
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Columbus, Ohio, United States, 43205
- Nationwide Children's Hospital
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Washington
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Seattle, Washington, United States, 98105
- Seattle Children's Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients age 1-23 months seen at a participating site for bronchiolitis
- Providers at participating sites that see eligible patients (defined above)
- Parents who have an eligible child at participating study sites (parent interviews)
Exclusion Criteria:
- Patients outside the age limits and do not have bronchiolitis
- Providers not at participating site
- Parents who do not have an eligible child at participating study site.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: High use hospitals
patients 1-23 months with Bronchiolitis seen in emergency department, urgent care or admitted patients will be included; provider surveys measuring the acceptability, appropriateness, feasibility, and perceived burden of piloted strategies; review of patient data extracted from electronic health record to include baseline, intervention and post-intervention data
|
De-implementation strategy to reduce over-use of treatments for patients with bronchiolitis
|
No Intervention: Low use hospital (Children's Hospital Colorado)
patients 1-23 months with Bronchiolitis seen in emergency department, urgent care or admitted patients will be included; review of patient data extracted from electronic health record to include data over the same time periods as the experimental groups' baseline, intervention, and post-intervention data
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Using survey instruments developed by the research team, measure acceptability of the de-implementation strategies for bronchiolitis patients at high-use hospital
Time Frame: through study completion, an average of 1 year
|
Online surveys will be given to providers care team members that experience the de-implementation strategies at the high-use hospitals to determine acceptability and appropriateness
|
through study completion, an average of 1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Measure de-implementation effectiveness
Time Frame: through study completion, an average of 1 year
|
Looking at electronic health records, review the change in the utilization rates of CXR, bronchodilators, and VT for patients affected with bronchiolitis at all hospitals
|
through study completion, an average of 1 year
|
Measure feasibility of deploying ROUTT-B from the perspectives of the quality improvement team who will deploy it.
Time Frame: through study completion, an average of 1 year
|
Measured through mixed methods approach (qualitative interviews or focus groups and provider surveys)
|
through study completion, an average of 1 year
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients receiving antibiotics
Time Frame: through study completion, an average of 1 year
|
using electronic health records of patient population at both hospitals
|
through study completion, an average of 1 year
|
Median length of hospitalization in hours
Time Frame: through study completion, an average of 1 year
|
using electronic health records of patient population at all hospitals
|
through study completion, an average of 1 year
|
Unintended consequences
Time Frame: through study completion, an average of 1 year
|
7 day ED/UC all cause revisits, 7 day all cause readmissions, ICU level care at index visit at all hospitals
|
through study completion, an average of 1 year
|
Stakeholders' perceptions of impact on patient outcomes
Time Frame: through study completion, an average of 1 year
|
measured through provider and care team survey at high-use hospitals.
|
through study completion, an average of 1 year
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Amy Tyler, MD, Nationwide Children's Hospital
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 19-0728
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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