Equity in Diagnostic Imaging Trial (EDIT)
Equity in Diagnostic Imaging Trial (EDIT)
調査の概要
詳細な説明
Investigators at our institution (Hwang & Richardson)* documented a racial disparity in the use of CT scans to diagnose subarachnoid hemorrhage, (SAH) a life-threatening form of stroke. Subsequent analyses found a similar finding in NHAMCS, a national ED Visit database*. The investigators will compare the effectiveness of 1) an audit-feedback intervention that provides data on race-specific CT rates and 2) a clinical decision support (CDS) message in the electronic "headache" charting template in eliminating the previously observed Black-White disparity in CT rates to rule out SAH.
Study Setting: The adult section of the Mount Sinai Emergency Department, an urban academic department with an annual volume of over 70,000 adult visits and a patient population representing a diverse cross-section of race and socioeconomic groups. The adult patients are cared for by a staff that includes: attending physicians, physician assistants, emergency medicine resident physicians, and rotating resident physicians from other specialties. The department has a dedicated CT scanner that is readily available around the clock. Epic Production is used for all physician and nurse documentation and for all order entry (including CT scans).
Over a 24-month period the investigators will compare the intervention and control groups' rates of testing for SAH across races, controlling for patient acuity, age and co-morbidities. Because the close working relationships among the attending and resident physicians in our department may lead to knowledge diffusion, the intervention may change the behavior of the control group as well as the intervention group, thus leading to an underestimation of the intervention effect as measured by the between- groups difference. The investigators will use a time series design to allow us to evaluate this effect. 10 months after the implementation of the first intervention, the clinical decision support message will be implemented. The impact of each intervention will be evaluated using a repeated measures design using a mixed linear model.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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New York
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New York、New York、アメリカ、10029
- Icahn School of Medicine at Mount Sinai
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
Attending Physicians, Emergency Room Resident Physicians, and PA's will be included if:
- they provide care to adult patients in the emergency department of Mount Sinai Hospital.
Patients will be enrolled for medical record review if
- they present with a complaint of headache and charted on the headache template in the period between four years pre-intervention and the end of the study period.
Exclusion Criteria:
- anyone who does not meet the inclusion criteria will be excluded from the study
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:階乗代入
- マスキング:独身
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Audit-feedback
Arm 1: Audit-feedback only
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Clinicians will receive a short email educational message at regular intervals alerting them to the historic disparities in diagnostic workup for SAH in our department and reminding them of the increased risk of SAH among African-American patients.
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実験的:CDS message
Arm 2: CDS message only
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Clinicians receive an embedded real-time Best Practice Alert (BPA) of increased rates of SAH among African-Americans when they open the "headache" electronic charting template.
他の名前:
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実験的:Both Interventions
Arm 3: Audit-feedback and CDS message
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Clinicians will receive a short email educational message at regular intervals alerting them to the historic disparities in diagnostic workup for SAH in our department and reminding them of the increased risk of SAH among African-American patients.
Clinicians receive an embedded real-time Best Practice Alert (BPA) of increased rates of SAH among African-Americans when they open the "headache" electronic charting template.
他の名前:
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介入なし:Control
Arm 4: Control
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Change in CT usage rate
時間枠:up to 24 months
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What is the impact of the email intervention, CDS intervention, and combined intervention on black-white difference in CT rates?
A successful intervention should lead to a significant main effect for each experimental arm.
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up to 24 months
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協力者と研究者
捜査官
- 主任研究者:Lynne D Richardson, MD、Icahn School of Medicine at Mount Sinai
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
Audit-feedbackの臨床試験
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Vanderbilt UniversityNational Institute of Mental Health (NIMH); Leon Lowenstein Foundation Inc.完了
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Groupe Hospitalier de la Region de Mulhouse et...完了
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Region StockholmKarolinska Institutet; Forte; Sophiahemmet University募集
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Centre Hospitalier Universitaire de Nīmes募集
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The University of Hong Kong募集
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The University of Hong Kong募集