AI Article Synopsis
- The paper discusses a trial aimed at reducing unnecessary continuous pulse oximetry monitoring in children not receiving supplemental oxygen, in line with national guidelines.
- The study compares two strategies: unlearning overused practices and unlearning plus substituting with more appropriate interventions, focusing on their effectiveness in sustaining the reduction of monitoring.
- The trial's design includes a longitudinal analysis of outcomes related to hospital stay and oxygen use, intending to provide valuable insights into how to effectively implement deimplementation strategies in healthcare.
Article Abstract
Background: Deimplementing overused health interventions is essential to maximizing quality and value while minimizing harm, waste, and inefficiencies. Three national guidelines discourage continuous pulse oximetry (SpO) monitoring in children who are not receiving supplemental oxygen, but the guideline-discordant practice remains prevalent, making it a prime target for deimplementation. This paper details the statistical analysis plan for the Eliminating Monitor Overuse (EMO) SpO trial, which compares the effect of two competing deimplementation strategies (unlearning only vs. unlearning plus substitution) on the sustainment of deimplementation of SpO monitoring in children with bronchiolitis who are in room air.
Methods: The EMO Trial is a hybrid type 3 effectiveness-deimplementation trial with a longitudinal cluster-randomized design, conducted in Pediatric Research in Inpatient Settings Network hospitals. The primary outcome is deimplementation sustainment, analyzed as a longitudinal difference-in-differences comparison between study arms. This analysis will use generalized hierarchical mixed-effects models for longitudinal clustering outcomes. Secondary outcomes include the length of hospital stay and oxygen supplementation duration, modeled using linear mixed-effects regressions. Using the well-established counterfactual approach, we will also perform a mediation analysis of hospital-level mechanistic measures on the association between the deimplementation strategy and the sustainment outcome.
Discussion: We anticipate that the EMO Trial will advance the science of deimplementation by providing new insights into the processes, mechanisms, and likelihood of sustained practice change using rigorously designed deimplementation strategies. This pre-specified statistical analysis plan will mitigate reporting bias and support data-driven approaches.
Trial Registration: ClinicalTrials.gov NCT05132322. Registered on 24 November 2021.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568304 | PMC |
| http://dx.doi.org/10.1016/j.conctc.2023.101219 | DOI Listing |
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